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COURSE  OF  LECTURES  ^  ^ 


ON  THE 


PHYSIOLOGY  AND  PATHOLOGY 


CENTRAL  NERYO US  SYSTEM. 


DELIVERED  AT  THE 


gopl  tf Allege  tf  Snxpni  of  tfngtatr  in  pg,  1858. 


BY 

C.  E.  BROWN-SEQUARP,  M.  D.,  F.R.S., 

FELLOW  OF  THE  ROYAL  COLLEGE   OF  PHYSICIANS,  OF  LONDON  J   HON.  FELLOW  OF   TOE   FACULTY  OF 

PHYSICIANS  AND  SURGEONS,  GLASGOW  J   LAUREATE  OF  THE  INSTITUTE  OF  FRANCE  (ACADEMY 

OF  SCIENCES)  ;  PHYSICIAN  TO  THE  NATIONAL  HOSPITAL  FOR  THE  PARALYZED  AND  THE 

EPILEPTIC  J   EX-PROFESSOR  OF   THE   INSTITUTES  OF  MEDICINE  AT  THE  MEDICAL 

COLLEGE  OF  VIRGINIA,  U.S.;  FELLOW  OF  THE  ROYAL  MEDICO-CHIRURGICAL 

SOCIETY    OF   LONDON;    EX-SECRETARY  AND    VICE-PRESIDENT    OF 

THE  SOCIETE  DE  BIOLOGIE,  OF  PARIS,  ETC. 


PHILADELPHIA: 
COLLINS,   PRINTER,   705  JAYNE   STREET. 

1860. 


Historical  Collection 


Entered  according  to  Act  of  Congress,  in  the  year  1858,  by 

E.  BROWN-SEQUARD,  M.P., 

in  the  Clerk's  Office  of  the  District  Court  of  the  United  States  for  the  Eastern 
District  of  Pennsylvania. 


TO 


HENRY   J.    FELTUS,  Esq., 

OF   PHILADELPHIA,   U.   S., 


JULES     CHAUVIN,    Esq., 

OF   PORT-LOUIS,   MAURITIUS. 

My  Dear  Friexds  : — 

Had  it  not  been  for  the  assistance  I  owe  to  your 
extreme  kindness,  it  is  probable  that  the  publication  of  the 
present  edition  of  these  Lectures,  in  book  form,  would  have 
been  much  delayed;  I  therefore  take,  with  great  pleasure, 
this  opportunity  of  publicly  expressing  to  you  my  very  best 
thanks. 

Your  devoted  friend, 

C.  E.  BROYYX-SEQUARD. 

London,  September,  I860. 


PREFACE. 


These  Lectures  contain  the  results  of  the  work  of 
almost  all  my  life,  since  I  began  to  study  medicine.  From 
the  year  1838  to  the  year  1858,  when  I  had  the  honor  of 
delivering  them  at  the  Hoyal  College  of  Surgeons,  in  Lon- 
don, and  ever  since,  I  have  devoted  all  the  time  I  could  to 
the  study  of  the  great  questions,  the  solution  of  which  I 
have  tried  to  give  in  these  Lectures.  If  I  have  not  suc- 
ceeded in  my  endeavors,  I  can  at  least  have  this  consola- 
tion, that  it  is  not  because  I  have  proceeded  hastily.  But, 
however  prolonged  my  researches  have  been,  I  am  afraid  I 
must  have  come  to  erroneous  conclusions  on  several  points, 
because  the  questions  discussed  in  these  Lectures  are  as 
difficult  as  they  are  important,  and  also  because  many  of 
these  questions  are  quite  new,  and  I  had  not,  therefore,  the 
views  of  other  authors  to  guide  me  in  their  examination. 
I  will  be  thankful  to  any  one  who  will  show  me  on  what 
points  I  have  erred.  It  is  in  the  power  of  most  medical 
practitioners  to  prove  or  to  disprove  the  views  I  hold. 
Out  of  the  millions  of  patients  yearly  treated  by  the 
medical  men  who  may  peruse  this  book,  there  are,  indeed, 
many  thousands  whose  cases  may  throw  light,  and  often  a 
decisive  light,  on  the  questions  discussed  in  the  following 
pages.     As  most  of  these   questions   are  of  the  greatest 


VI  PREFACE. 

importance,  both  in  a  practical  and  in  a  scientific  point  of 
view,  I  hope  that  those  who  will  peruse  this  work  will  not 
let  the  cases  pass  unrecorded  that  may  be  the  means  of 
settling  what  is  yet  undecided  in  these  questions,  or  of 
giving  more  strength  to  the  proofs  of  the  views  held  by 
myself  or  by  my  opponents. 


C.  E.  BROWN-SEQUARD. 


London,  #1  "Wyiji/uui  D/ki/ji'. 
S. ^Cavendish  Square, 
W. 


TABLE  OF  CONTENTS. 


LECTURE  I. 

TRUTH  OF  SIR  CHARLES  BELL'S  THEORY  AS  REGARDS  THE  EXISTENCE 
OF  TWO  DISTINCT  SETS  OF  NERVOUS  CONDUCTORS :— THE  SENSITIVE 
AND  THE  MOTOR. 

Importance  of  comparing  experiments  upon  animals  with  pathological  cases  ob- 
served in  man. — Discovery  of  Sir  Charles  Bell ;  removal  of  the  last  objections 
to  his  views  in  regard  to  the  roots  of  the  spinal  nerves. — The  pretended  re- 
curring sensibility  of  Magendie.  Causes  of  the  pain  produced  by  the  irritation 
of  the  anterior  roots  of  nerves,  of  the  pain  of  cramps,  of  certain  "contractures,"  of 
the  spasm  of  the  sphincter  ani,  and  of  the  contractions  of  the  uterus  during  par- 
turition, &c. — Are  the  sensitive  nerve-fibres  of  muscles  contained  in  the  anterior 
roots  of  the  spinal  nerves  ? — Theories  concerning  the  transmission  of  the  sensi- 
tive impressions  in  the  spinal  cord  and  the  medulla  oblongata      .         .     page  1 


LECTURE   II. 

EXPERIMENTS  SHOWING  THAT  THE  TRANSMISSION  OF  THE  SENSITIVE 
IMPRESSIONS,  IN  THE  SPINAL  CORD,  TAKES  PLACE  CHIEFLY  IN  ITS  CEN- 
TRAL PART— i.  e.,  IN  THE  GRAY  MATTER. 

Experiments  and  views  of  Longet. — Objections  by  Dr.  R.  B.  Todd,  Mr.  Lockhart 
Clarke,  and  the  Lecturer. — Causes  of  error  in  experimenting  upon  the  spinal 
marrow. — Experiments  proving  that  a  part  may  be  a  conductor  of  the  sensitive 
impressions,  though  not  endowed  with  sensibility. — Experiments  showing,  1st, 
that  a  transversal  section  of  the  posterior  columns  of  the  spinal  cord,  instead 
of  causing  anaesthesia,  is  followed  by  hyperesthesia  ;  2d,  that  a  transversal  sec- 
tion of  the  whole  spinal  cord,  except  the  posterior  columns,  is  followed  by  a 
complete  ansesthesia.  Anatomical  and  experimental  facts  showing  the  relative 
share  of  the  gray  matter,  and  of  the  various  columns  of  white-  matter,  in  the 
transmission  of  the  sensitive  impressions  .......       13 


Vlll  CONTENTS. 


LECTURE    III. 

PLACE  OF   DECUSSATION   OF   THE  CONDUCTORS   OF   SENSITIVE 
IMPRESSIONS,  IN  THE  CEREBROSPINAL  AXIS. 

The  celebrated  experiments  of  Galen,  which  had  been  universally  considered  as 
showing  that  there  is  no  decussation  of  the  conductors  of  sensitive  impres- 
sions, in  the  spinal  cord,  do  not  prove  anything  in  this  respect. — Experiments 
showing  that  the  conductors  of  sensitive  impressions  from  the  various  parts 
of  the  trunk  and  limbs  make  their  decussation  in  the  spinal  cord,  and  not  in 
the  encephalon,  as  was  admitted 29 


LECTURE   IV. 

ON  VARIOUS  QUESTIONS  RELATING  TO  THE  TRANSMISSION  OF  SENSI- 
TIVE IMPRESSIONS  AND  OF  THE  ORDERS  OF  THE  WILL  TO  MUSCLES, 
THROUGH  THE  SPINAL  CORD  AND  THE  MEDULLA  OBLONGATA. 

Most  of  the  elements  which  are  employed  as  conductors  of  the  purely  tactile  im- 
pressions seem  to  pass  by  the  same  parts  of  the  spinal  cord  as  those  which 
transmit  the  impressions  which  give  pain. — The  disposition  of  the  conductors  of 
the  various  sensitive  impressions  in  the  spinal  cord  is  such  that  very  deep  alte- 
rations of  this  organ  may  not  entirely  destroy  sensibility. — The  gray  matter  of 
the  spinal  cord  seems  to  have  an  important  share  in  the  transmission  of  the 
orders  of  the  will  to  muscles. — The  anterior  columns  of  the  spinal  cord  in  the 
upper  part  of  the  cervical  region  have  but  a  slight  participation  in  voluntary 
movements,  and  the  lateral  columns,  with  the  surrounding  gray  matter,  in  that 
part  of  the  cord,  are  almost  the  only  channels  between  the  will  and  muscles       39 


LECTURE   V. 

CONCLUSIONS  FROM  THE  FACTS  MENTIONED  IN  THE  PRECEDING  LEC- 
TURES, AND  PATHOLOGICAL  CASES  SHOWING  THAT  THE  TRANSMIS- 
SION OF  SENSITIVE  IMPRESSIONS  SEEMS  NOT  TO  TAKE  PLACE  THROUGH 
THE  POSTERIOR  COLUMNS  OF  THE  SPINAL  CORD. 

Conclusions  from  the  results  of  the  Lecturer's  experiments  concerning  the  trans- 
mission of  sensitive  impressions  and  of  the  orders  of  the  will  to  muscles,  in  the 
cerebro-spinal  axis. — Agreement  between  the  three  principal  sources  of  our 
knowledge  concerning  the  spinal  cord  considered  as  a  conductor  of  sensitive 
impressions  and  voluntary  movements  :  i.  e.,  anatomy,  experimentation  upon 
animals,  and  pathological  cases  observed  in  man. — Hyperesthesia  or  conserva- 
tion of  sensibility  after  injury  to  the  posterior  columns      .         .         .         .50 


CONTENTS. 


LECTURE   VI. 

SOLUTION  BY  PATHOLOGICAL  CASES,  OF  VARIOUS  QUESTIONS  RELATING 
ST0ThE   TRANSMISSION   OE    SENSITIVE    IMPRESSIONS   THROUGH   THE 
SPINAL  CORD. 

the  evidence  as  regards  the  share  of  tlie  gray  matter  in  ^       ^ 

sitive  impressions       .'.***" 

LECTURE  VII. 

PATHOLOGICAL  CASES  SHOWING  THAT  THE  CONDUCTORS  OE  SENSITIVE 
IMPRESSIONS  EROM  THE  TRUNK  AND  LIMBS  DECUSSATE  IN  THE  SPINAL 
CORdTnD  NOT  IN  THE  ENCEPHALON,  AND  THAT  THE  CONDUCTORS  OE 
Te  ORDERS  OE  THE  WILL  TO  MUSCLES  DECUSSATE  IN  THE  LOWER 
™RT  OE  THE  MEDULLA  OBLONGATA  AND  NOT  IN  THE  PONS  VAROLII. 

TLe  dec—  of  the  co—  of  -^^S^j^SJ - 
limbs,  *.  not  ta,e  plaoe  »*.  « -£.  —  ^  J  ^  ^  h 

i    the  medu  a  ^f^s7fSv^tafy  movements  in  one  side  of  the  body 
^Tlts    t^sTbity  in  the  opposite  side.-The  decussation  of  the  con- 

"of  the  cncephaPlon!aS  regards  voluntary  movements  and  sensdnhty      93 


CONTENTS, 


LECTURE  VIII. 

CONCLUSIONS  FROM  THE  PATHOLOGICAL  CASES  RELATED  IN  THE  PRE- 
CEDING  LECTURES  AND  FROM  SEVERAL  OTHER  CASES,  AS  REGARDS 
THE  DIAGNOSIS  OF  ALTERATIONS  OF  THE  VARIOUS  PARTS  OF  THE 
SPINAL  CORD. 

Principal  symptoms  of  the  diseases  of  tlie  spinal  cord. — On  a  curious  symptom 
which  seems  to  belong  especially  to  diseases  of  this  organ. — Cases  against  the 
views  of  Bellingeri  and  Valentin,  relative  to  the  pretended  motor  functions  of 
the  posterior  columns,  and  to  certain  symptoms  of  alterations  of  the  anterior 
columns. — Differences  in  the  degree  of  paralysis  of  voluntary  movements, 
according  to  the  extent  of  the  alteration  of  the  posterior  columns. — Absence 
of  paralysis,  in  cases  in  which  these  columns  are  entirely  cut  across,  but  not 
injured,  in  a  great  part  of  their  length. — Causes  and  nature  of  the  apparent 
paralysis  observed  when  a  great  part  of  the  length  of  the  posterior  columns  is 
altered. — Alteration  of  the  upper  part  of  the  anterior  columns  without  para- 
lysis.— Decussation  of  the  lateral  columns ;  their  function  and  symptoms  of 
their  alteration. — Paralysis  due  to  disease  of  the  gray  matter. — Alterations 
causing  a  loss  of  feeling  a  contact,  a  tickling,  a  muscular  contraction,  a  painful 
impression,  or  a  change  of  temperature. — Conclusions  concerning  anaesthesia. — 
When  does  anaesthesia  exist  without  a  notable  paralysis. — Rarity  of  complete 
anaesthesia. — Referring  of  the  various  kinds  of  sensitive  impressions  to  different 
parts  of  the  body  in  cases  of  alteration  of  the  spinal  cord. — Absence  of  excita- 
bility of  most  of  the  conductors  of  the  various  kinds  of  sensitive  impressions 
in  the  nerves  and  in  the  spinal  cord. — Inflammation  may  render  all  these  con- 
ductors excitable,  and  induce  the  production  of  all  kinds  of  sensations,  errone- 
ously referred  to  the  periphery. — Groups  of  symptoms  which  characterize 
alterations  limited  to  certain  parts  of  the  various  columns  of  the  spinal  cord 
and  of  its  gray  matter 112 


LECTURE    IX. 

ON  THE  PHYSIOLOGICAL  AND  MORBID  ACTIONS  DUE  TO  THE 
GREAT  SYMPATHETIC  NERVE. 

Effects  of  a  section  of  the  sympathetic  nerve  in  the  cervical  region. — Effects  of  the 
excitation  of  the  same  nerve,  in  the  same  region,  by  a  galvanic  or  an  electro- 
magnetic current. — Almost  all  the  effects  due  to  the  section  or  galvanization  of 
this  nerve  are  owing  to  the  condition  of  bloodvessels  after  these  operations. — 
The  sympathetic  nerve  originates  chiefly  from  the  cerebro-spinal  axis. — Simili- 
tude between  the  effects  of  a  section  of  the  sympathetic  nerve,  and  those  of  a 
section  of  a  lateral  half  of  the  spinal  cord. — Persistence  of  a  contraction  of 
bloodvessels  due  to  irritation  of  the  cerebro-spinal  axis  in  certain  diseases. — 
Two  kinds  of  normal  or  morbid  influences  of  the  nervous  system  upon  nutri- 
tion, secretion,  &c. ;  one  upon  bloodvessels,  the  other  upon  tissues     .         .     139 


CONTENTS.  XI 


LECTURE   X. 

ON  THE  INFLUENCE  OF  THE  NERVOUS  SYSTEM  UPON  NUTRITION  AND 
SECRETION;  WITH  REMARKS  ON  THE  IMPORTANCE  OF  THE  KNOW- 
LEDGE OF  THIS  INFLUENCE  FOR  THE  TREATMENT  AND  THE  EXPLA- 
NATION OF  THE  PRODUCTION  OF  MANY  DISEASES. 

Distinction  between  the  effects  of  the  excitation  of  the  nervous  system  and  those 
of  the  absence  of  action  of  this  system. — Three  kinds  of  reflex  actions :  contrac- 
tion, secretion,  and  modification  of  nutrition. — Normal  and  morbid  reflex  secre- 
tions.— Normal  and  morbid  reflex  changes  in  nutrition. — Reflex  influence  of 
injuries  of  the  trigeminal  nerve  upon  the  eye. — Reflex  influence  of  one  eye  upon 
the  nutrition  of  the  other. — Sudden  arrest  of  the  heart's  movements  by  a  reflex 
action. — Cause  of  the  rapid  death  after  injuries  of  the  abdominal  sympathetic 
nerve. — Stoppage  of  the  heart's  movements  by  the  application  of  cold  to  the  skin, 
by  the  influence  of  cold  drinks,  and  in  some  cases  of  death  by  chloroform. — 
Reflex  influence  of  burns  on  the  principal  viscera. — Inflammation  of  the  eyes,  of 
the  testicles,  of  the  nervous  centres,  &c,  by  a  reflex  action. — Muscular  atrophy 
due  to  an  irritation  of  sensitive  nerves. — Paralysis  and  anaesthesia  due  to  a  reflex 
action. — Disturbance  of  the  functions  of  the  brain  and  of  the  senses  produced  by 
irritation  of  centripetal  nerves. — Other  instances  of  reflex  changes  of  nutrition. — 
Mode  of  production  of  the  secretory  and  nutritive  reflex  actions. — Importance  of 
the  knowledge  of  the  reflex  secretory  and  nutritive  phenomena  for  the  treatment 
of  disease. — Influence  of  the  irritation  of  the  nervous  centres  and  of  the  centri- 
fugal nerves  on  nutrition  and  secretion. — Influence  of  the  absence  of  nervous 
action  on  nutrition,  repair  and  secretion 151 


LECTURE   XI. 

ON  THE  ETIOLOGY,  NATURE,  AND  TREATMENT  OF  EPILEPSY,  WITH  A 
FEW  REMARKS  ON  SEVERAL  OTHER  AFFECTIONS  OF  THE  NERVOUS 
CENTRES. 

Artificial  production  of  an  epileptiform  affection  in  animals. — Influence  of  certain 
injuries  to  the  spinal  cord  as  a  cause  of  real  epilepsy. — Existence  of  an  unfelt 
aura  epileptica  in  many  cases. — Means  of  detecting  the  existence  of  an  unfelt 
aura  and  its  point  of  starting. — Seat  and  nature  of  epilepsy. — Principles  of  treat- 
ment of  this  affection. — Analogy  between  epilepsy  and  many  other  nervous  affec- 
tions, as  regards  their  mode  of  production  and  their  treatment. — Curious  case  of 
convulsions  and  insanity,  in  illustration  of  some  views  advanced  in  this  letter 

178 


Xll  CONTEXTS, 


LECTURE   XII. 

ON  THE  MEDULLA  OBLONGATA,  THE  PONS  VAROLII,  AND  SOME  PARTS 
OF  THE  SPINAL  CORD,  IN  THEIR  RELATIONS  WITH  RESPIRATORY  MOVE- 
MENTS ;  WITH  VERTIGINOUS  OR  ROTATORY  CONVULSIONS  ;  WITH  THE 
TRANSMISSION  OF  SENSITIVE  IMPRESSIONS  AND  OF  THE  ORDERS  OF 
THE  WILL  TO  MUSCLES,  AND  WITH  THE  VASO-MOTOR  NERVES  AND 
ANIMAL  HEAT.— GENERAL  CONCLUSIONS  OF  THE  COURSE. 

Medulla  oblongata  erroneously  considered  as  the  source  or  focus  of  life. — Causes 
of  death  in  cases  of  sudden  injury  to  this  organ. — Respiration  depending  upon 
other  parts  of  the  cerebrospinal  axis,  besides  the  medulla  oblongata. — Causes 
of  the  cessation  of  respiration  in  cases  of  a  complete  section  of  the  medulla 
oblongata. — How  are  the  respiratory  movements  produced  ? — Parts  of  the  ence- 
phalon  and  spinal  cord  that  may  produce  rotatory  convulsions. — Causes  of  the 
vertiginous  or  rotatory  convulsions. — The  auditory  nerve  and  its  power  of  pro- 
ducing partial  or  general  convulsions. — The  olivary  and  restiform  columns  of 
the  medulla  oblongata  and  their  relations  with  various  nervous  disturbances. — 
Reasons  against  the  view  that  the  fibres  which  decussate  all  along  the  median 
line  of  the  base  of  the  encephalon  are  voluntary  motor  fibres. — Reasons  for 
admitting  that  the  anterior  pyramids  contain  nearly  all  the  voluntary  motor 
fibres  of  the  body. — Three  kinds  of  paralysis  due  to  lesions  in  three  different 
parts  of  the  cerebro-spinal  axis. — Anaesthesia  and  hyperesthesia  in  their  rela- 
tions with  the  state  of  bloodvessels  and  the  degree  of  animal  heat. — Condition 
of  voluntary  movements,  sensibility,  and  animal  heat,  in  different  cases  of 
alteration  of  the  central  nervous  system. — General  conclusions  .         .         .     187 


APPENDIX 


Part  I. — Examination  of  objections  that  might  be   made  against   many  of  the 
views  which  are  held  in  the  preceding  lectures 211 

Part  II. — Application  of  some  of  the  facts  and  views  exposed  in  the  preceding 
lectures,  to  the  treatment  of  disease 244 

Part  III.— Additional  facts  in  proof  of  some  of  the  views  of  the  author       .     2(33 


THE 


CENTRAL  NERVOUS   SYSTEM 


LECTURE    I.1 


TRUTH  OF  SIR  CHARLES  BELL'S  THEORY  AS  REGARDS  THE  EXISTENCE 
OF  TWO  DISTINCT  SETS  OF  NERVOUS  CONDUCTORS ;  THE  SENSITIVE 
AND  THE  MOTOR. 

Importance  of  comparing  experiments  upon  animals  with  pathological  cases  ob- 
served in  man. — Discovery  of  Sir  Charles  Bell ;  removal  of  the  last  objections 
to  his  views  in  regard  to  the  roots  of  the  spinal  nerves. — The  pretended  re- 
cnrring  sensibility  of  Magendie.  Causes  of  the  pain  produced  by  the  irritation 
of  the  anterior  roots  of  nerves,  of  the  pain  of  cramps,  of  certain  "  contractures,"  of 
the  spasm  of  the  sphincter  ani,  and  of  the  contractions  of  the  uterus  during  par- 
turition, &c. — Are  the  sensitive  nerve-fibres  of  muscles  contained  in  the  anterior 
roots  of  the  spinal  nerves  ? — Theories  concerning  the  transmission  of  the  sensi- 
tive impressions  in  the  spinal  cord  and  the  medulla  oblongata. 

Mr.  President  and  Gentlemen:  The  subject  of  the  lectures 
which  I  propose  delivering  here  is  a  very  vast  one,  as  it  includes, 
directly  or  indirectly,  most  of  the  principal  questions  concerning 
the  Physiology  and  Pathology  of  the  Nervous  System.  But  vast 
as  it  is,  this  subject  may  be  considered  as  composed  of  only  three 
essential  parts,  which  relate  to  the  sensitive,  the  motor,  and  the 
vaso-motor  nerve-fibres.  In  other  words,  I  propose  to  examine 
successively  the  principal  facts  and  views  concerning  the  normal 
actions,  and  the  consequences  of  the  excess  or  of  the  absence  of 
action,  of  these  three  kinds  of  nerve-fibres. 

1  Although  six  lectures  only  were  delivered  at  the  Royal  College  of  Surgeons, 
I  will  publish  here  twelve  lectures,  covering  just  the  same  ground  as  those  of  the 
College,  but  differing  from  them  in  this  respect,  that  I  give  here  details  concerning 
experiments  and  pathological  cases,  which,  for  the  sake  of  brevity,  I  was  obliged 
to  omit  when  lecturing. 

A 


Z  THE    CENTRAL    NERVOUS    SYSTEM. 

To  try  to  solve  the  very  important  but  complicated  questions 
which  are  so  numerous  in  both  the  physiological  and  the  patho- 
logical history  of  the  parts  of  these  nerve-fibres  which  are  in  the 
nervous  centres,  it  is  necessary  to  make  use  of  all  the  means  that 
science  may  furnish,  and  particularly  of  the  two  best,  which  are: 
experimentation  upon  living  animals,  and  observation  of  pathologi- 
cal cases.  When  employed  together,  these  means  of  scientific  re- 
search have  allowed  errors  to  be  made;  but,  of  course,  the  chance 
of  committing  errors  is  by  far  greater  when  either  of  them  is  em- 
ployed alone.  The  danger  of  making  use  of  one  of  these  means 
exclusively  is  very  strikingly  illustrated  by  the  many  errors,  con- 
cerning the  cerebellum,  committed  by  experimental  physiologists, 
who  mistook  the  effects  of  certain  circumstances  of  their  experi- 
ments for  the  results  of  injuries  or  of  the  absence  of  the  cerebellum. 
Had  they  taken  the  trouble  of  comparing  the  phenomena  they  saw 
with  those  observed  by  medical  men  in  cases  of  disease  of  the  cere- 
bellum, they  would  not  have  introduced  in  science  a  number  of 
hypotheses  which  impede  its  progress.  It  is  by  so  doing  that  ex- 
perimentalists have  thrown  discredit  on  the  means  of  scientific  in- 
quiry of  which  they  have  made  so  much  use  and  abuse,  and  have 
given  ground  to  many  critics  to  blame  their  means  of  research,  while 
the  fault  was  in  the  men  who  employed  those  means,  and  not  in  the 
means  themselves. 

If  erroneous  views  have  been  arrived  at  by  the  exclusive  use  of 
one  of  the  means  of  scientific  research  we  have  named,  we  find  that, 
on  the  contrary,  many  great  advances  in  the  medical  sciences  are 
due  to  the  combined  use  of  vivisections  and  clinical  observation. 
Perhaps  I  may  be  allowed  to  say  that  the  lectures  I  am  about 
delivering  will  afford  some  proof  of  the  advantage  of  a  comparison 
of  pathological  cases  observed  in  man,  with  the  result  of  experi- 
ments upon  living  animals. 

The  great  discovery  of  Sir  Charles  Bell  gives  a  good  instance  of 
the  importance  of  making  use  comparatively  of  clinical  observation 
and  vivisections.  In  fact,  had  Sir  Charles  had  recourse  to  experi- 
ments upon  living  animals,  he  probably  would  have  succeeded,  at 
once,  in  proving  the  correctness  of  his  theory  concerning  the  roots 
of  the  spinal  nerves. 

Before  him,  already,  many  physiologists  had,  more  or  less  dis- 
tinctl}7,  foreseen  that  the  nervous  conductors  for  voluntary  move- 
ments and  those  for  sensation  form  two  distinct  sets  of  nerves. 
Galen,  Boerhaave,  Lamarck,  Alex.  Walker,  and  others,  had  had  this 


THEOEY  OF  SIR  CHARLES  BELL.  3 

idea.  To  Alex.  "Walker  the  credit  is  due  of  having  first  published 
this  opinion,  that  there  is  a  difference  in  the  functions  of  the  ante- 
rior and  posterior  roots  of  the  spinal  nerves,  one  set  being  employed 
for  volition  and  the  other  for  sensation;  but  he  did  not  try  to  prove, 
either  by  experiments  or  by  pathological  facts,  the  correctness  of 
his  views;  and,  led  by  erroneous  ideas  concerning  the  function  of 
the  cerebellum,  he  imagined  that  the  anterior  roots  of  the  spinal 
nerves  are  for  sensation  and  the  posterior  for  motion.  (See  the 
Archives  of  Universal  Science  for  April  and  July,  1809.) 

It  was  only  two  years  after  the  publication  of  this  hypothesis  of 
Walker,  that  Sir  Charles  Bell's  first  views  received  some  publicity, 
in  the  celebrated  little  pamphlet,  entitled,  "An  Idea  of  a  New  Ana- 
tomy of  the  Brain,  submitted  for  the  Observation  of  the  Author's 
friends."1  In  this  wrork,  as  far  as  we  know,  he  did  not  try  to  prove 
that  the  anterior  roots  of  the  spinal  nerves  are  employed  as  con- 
ductors of  volition,  and  that  the  posterior  roots  are  the  conductors 
of  the  sensitive  impressions.  He  seems  not  to  have  yet  had  (at  that 
time)  the  idea  of  this  difference.  He  admitted  that  the  posterior 
roots  of  nerves  come  from  the  cerebellum,  which  he  considered  as 
an  organ  employed  for  the  organic  or  vital  functions  of  the  body, 
while  the  anterior  roots  are  in  communication  with  the  cerebrum, 
which  he  thought  to  be  the  organ  for  both  volition  and  sensitive 
perceptions.  But,  however  erroneous  may  be  some  of  these  views, 
we  look  upon  this  first  work  of  Sir  Charles  Bell  on  the  nervous 
system,  as  an  admirable  production  -of  the  genius  of  this  great 
physiologist.  The  idea  of  the  distinction  between  the  nervous  ele- 
ments employed  in  the  different  functions  of  the  nervous  system  is 
there  clearly  and  forcibly  presented,  and  we  may  safely  state  that 
the  greatest  part  of  the  recent  progress  of  our  knowledge  of  the 
nervous  system,  both  in  a  practical  and  in  a  scientific  point  of  view, 
has  its  source  in  this  idea.  There  is  another  important  thing  in 
this  little  pamphlet;  it  is  the  result  of  Sir  Charles  Bell's  experi- 
ments on  the  roots  of  the  spinal  nerves.  He  found,  on  a  dying 
animal,  that  the  irritation  of  the  anterior  roots  caused  muscular 
contractions,  while  there  was  no  effect  produced  by  the  irritation  of 
the  posterior  roots.  Of  course  this  experiment  could  not  show 
what  are  the  functions  of  these  roots,  but  it  was  sufficient  to  prove 

1  As  only  a  few  copies  of  this  pamphlet  were  printed,  it  is  now  almost  impossible 
to  procure  it.  I  speak  of  it  after  the  numerous  extracts  published  by  Mr.  Alex- 
ander Shaw  and  by  Sir  Charles  Bell  himself. 


4  THE    CENTRAL    NERVOUS    SYSTEM. 

that  there  is  a  notable  difference  between  the  anterior  and  the  pos- 
terior roots. 

Long  after  this  first  publication,  Sir  Charles  brought  forward 
several  facts,  experimental  and  pathological,  showing  that  the  nerv- 
ous conductors  for  motion  are  distinct  from  those  for  sensation.  He 
showed  that  the  facial  nerve  is  motor,  and  that  the  ganglionic  root 
of  the  trigeminal  is  for  sensation.  But  although  these  facts  had 
given  good  grounds  to  the  hypothesis  that  the  posterior  or  gan- 
glionic roots  of  the  spinal  nerves  are  used  for  sensation,  while  the 
anterior  roots  are  for  motion,  positive  evidences  of  the  exactitude 
of  this  distinction  were  still  wanted.  To  Mr.  Magendie  belongs  the 
merit  of  having  furnished  the  proofs  that  were  needed.  He  showed 
that  the  section  of  all  the  posterior  roots  of  the  nerves  of  one  limb 
destroys  the  sensibility  in  the  limb,  while  a  section  of  the  anterior 
roots  of  the  nerves  of  a  limb  abolishes  voluntary  movements,  leav- 
ing sensibility  unaltered.  He  also  found  that  strychnia,  in  this  last 
case,  does  not  excite  convulsions  in  the  paralyzed  limb,  while  there 
are  convulsions,  in  the  limb  deprived  of  sensibility,  after  the  section 
of  the  posterior  roots.  So  far  as  these  experiments  alone  are  studied, 
it  seems  quite  certain  that  the  anterior  roots  are  motor  and  not  sen- 
sitive, and  that  the  posterior  roots  are  sensitive  and  not  motor;  but 
Magendie  tried  other  experiments,  and,  not  being  aware  of  a  singular 
fact,  which  he  discovered  only  in  1839,  he  arrived  at  conclusions 
which  were  quite  different  from  those  just  exposed.  The  irritation 
of  the  anterior  roots  he  found  evidently  to  induce  pain,  though  in 
a  less  degree  than  that  of  the  posterior.  On  another  side  he  found 
sometimes  that  local  movements  took  place  when  he  irritated  the 
posterior  roots.  Here,  then,  are  two  facts  which  seem  in  direct  op- 
position to  the  theory  of  Sir  Charles  Bell. 

In  1839,  Magendie  made  a  step  forward,  and  discovered  a  very 
important  fact,  which  has  removed  the  objection  against  Sir  Charles 
Bell's  theory  as  regards  the  anterior  roots  of  the  spinal  nerves.  He 
found  that  these  roots  really  cause  pain  when  they  are  irritated,  but 
that  if  they  are  divided  (see  Fig.  1),  the  distal  end  (d)  alone  may 
give  pain.  He  ascertained  also  that  if  the  posterior  roots  of  any  of 
the  spinal  nerves  are  divided,  the  irritation  of  the  anterior  roots  of 
the  same  nerve  no  longer  causes  pain.  He  concludes,  from  these 
facts  and  some  others,  that  there  is  what  he  calls,  erroneously,  a 
recurring  sensibility,  which,  on  the  irritation  of  the  anterior  roots, 
manifests  itself  in  this  way :  The  nervous  irritation  which  causes 
the  pain  goes,  at  first,  from  the  parts  of  the  anterior  roots  (see  the 


THEORY  OF  SIR  CHARLES  BELL.  b 

arrows  in  Fig.  1,  a),  in  which  it  has  begun,  towards  the  trunk  of  the 
nerve,  in  which  it  goes  to  the  periphery  of  the  body,  and  then  comes 
back  towards  the  spinal  cord,  which  it  reaches  in  being  conveyed 
by  the  ganglion  (g)  and  the  posterior  roots  (p);  so  that  the  current 
which  proceeds  from  the  cord  along  the  anterior  roots  returns 
towards  it  and  into  it  along  the  posterior  ones.  We  must  say  that 
the  name  of  recurrent  sensibility  is  a  very  bad  one,  because  sensi- 
bility is  a  vital  property  which  cannot  move  from  a  place  towards 
any  other,  and  therefore  cannot  be  recurring.  It  is  the  cause,  what- 
ever it  may  be,  of  the  painful  sensation,  which  is  recurring,  and  not 
sensibility. 

What  is  the  channel  of  the  nervous  irritation  generated  when  the  ante- 
rior roots  are  excited?  In  the  first  place,  we  think  it  is  necessary  to 
repeat,  that  the  current  is  not  towards  the  spinal  cord,  inasmuch  as 
Ma^endie  has  well  Droved  that  after  the  section  of  the  anterior  roots 
of  a  spinal  nerve,  we  may  irritate  the  central  part  (Fig.  1,  c)  without 
causing  the  least  manifestation  of  any  kind  of  sensation.  It  results, 
therefore,  and  as  positively  as  possible,  that  the  anterior  roots  have 
not  the  property  of  sensibility  in  the  same  manner  as  the  really 
sensitive  parts.  On  the  contrary,  pain  is  caused  by  the  irritation 
of  the  parts  of  the  anterior  roots  in  appearance  separated  from  the 
nervous  centres.  (See  Fig.  1,  A,  d.)  But  if  the  trunk  of  the  nerve 
is  divided,  the  irritation  of  the  anterior  roots  on  either  end  remains 
completely  painless ;  it  results,  therefore,  that  the  current  which 
causes  the  pain  passes  in  this  trunk.  But  how  far  does  the  current 
extend  towards  the  periphery  of  the  body,  before  returning  upon 
itself  in  order  to  reach  the  spinal  cord  and  the  sensorium  ?  This  has 
not  been  positively  determined.  It  seems,  however,  already,  from 
the  experiments  of  Magendie,  of  Professor  CI.  Bernard,  of  Volk- 
mann,  of  Schiflf,  and  from  my  own,  that  the  return  takes  place  at 
the  peripheric  extremity  of  the  nerve-fibres.  Kronenberg  and  Pap- 
penheim  have  erroneously  admitted  that  the  current  merely  passes 
from  the  anterior  roots  to  the  posterior,  at  the  place  where  they 
meet  to  form  the  trunk  of  the  spinal  nerves. 

The  channel  of  the  current  which  gives  the  pain  when  an  ante- 
rior root  is  irritated,  is,  consequently,  at  first  towards  the  trunk  of 
the  nerve;  then  in  this  trunk  towards  the  periphery,  where  the 
recurrence  seems  to  take  place,  and  thence  the  current  returns  along 
the  sensitive  fibres  of  the  nerve  towards  the  ganglion  of  the  poste- 
rior roots,  and,  at  last,  passes  through  the  ganglion  and  these  roots, 
and  into  the  spinal  cord.  (See  the  upper  roots  in  Fig.  1.) 


6  THE    CENTRAL    NERVOUS    SYSTEM. 

What  is  the  cause  of  the  pain  produced  hy  the  irritation  of  the  anterior 
roots  of  nerves?  According  to  Carus,  the  Dervous  loops,  which  he 
thought  existed  in  the  muscles,  give  an  easy  explanation  of  the 
facts  discovered  by  Magendie.  Unfortunately  for  this  explanation 
(which  Mr.  Flourens  has  again  proposed  quite  recently),  the  exist- 
ence of  nervous  loops  in  muscles  is  now  disproved.  Indeed,  even  in 
the  skin  there  is  good  ground  to  doubt  the  presence  of  many  loops. 
Some  experiments,  which  we  have  made,  render  it  probable  that 
the  pain  caused  by  the  irritation  of  the  anterior  roots  is  exactly  of 
the  same  nature  as  that  of  cramps,  and  that  both  the  pain  of  cramps 
and  the  pain  which  we  will  call  recurrent,  to  avoid  circumlocutions, 
depend  upon  a  peculiar  kind  of  irritation  of  the  sensitive  nerves  of 
muscles.  The  theory  we  will  propose  is  also  applicable  to  many 
pathological  and  physiological  phenomena,  which  have  puzzled  for 
a  long  while  both  practitioners  and  physiologists,  and  which  seem, 
indeed,  to  be  very  plain  and  natural  now  that  we  have  the  key  to 
their  explanation. 

Professor  Matteucci,  nearly  twenty  years  ago,  found  that  when  a 
nerve  going  to  a  muscle  (Fig.  2,  m  2)  is  put  upon  another  muscle, 
a  contraction  takes  place  in  the  first  one  when  the  second  contracts. 
In  this  case  the  nerve  receives  an  excitation  at  the  time  the  muscle, 
upon  which  it  lies,  contracts.  The  cause  of  the  excitation  of  the 
nerve,  according  to  Professor  Matteucci,  is  a  galvanic  discharge 
which  accompanies  the  muscular  contraction.  Dubois-Reymond 
explains  otherwise  the  excitation  of  the  nerve,  lie  thinks  it  is  due 
to  a  diminution  of  the  galvanic  current  of  the  muscle  when  it  con- 
tracts, and  that  the  changes  occurring,  in  consequence,  in  the  nerve 
irritate  it.  But  whatever  be  the  right  explanation,  it  seems  certain 
that  it  is  some  change  in  the  galvanic  state  of  the  muscle  which  causes 
the  excitation  of  the  nerve.  \Ve  will,  therefore,  call  it  a  galvanic 
excitation.  Now,  I  have  tried  to  prove,  in  184:9,  that  the  sensitive 
nerve-fibres  which  are  in  muscles,  receive  that  peculiar  galvanic  ex- 
citation which  acts  upon  the  motor  nerves  in  the  case  of  the  pre- 
ceding experiment,  so  that  there  is  a  galvanic  cause  of  sensation  in 
muscular  contractions.  (See  Figs.  3  and  4,  and  their  explanations.) 
I  have  also  tried  to  show,  elsewhere,  that  our  faculty  of  guiding  our 
movements  depends  upon  the  sensations  that  we  have  of  the  state 
of  our  muscles,  from  the  galvanic  excitation  which  accompanies  our 
muscular  contractions.  I  cannot  dwell  at  length  here  upon  this 
explanation,  which  is  only  slightly  connected  with  my  subject;  but 


THEORY  OF  SIR  CHARLES  BELL.  7 

I  will  try,  at  least,  to  show  that  several  experiments  and  pathologi- 
cal cases  agree  perfectly  with  this  theory. 

If  we  fix  a  thread  to  the  tendon  of  a  muscle  of  a  frog  (see  Fig. 
2,  t),  and  attach  to  this  thread  a  weight,  capable  of  entirely  preventing 
the  contraction  of  the  muscle,  which  is  fixed  by  its  other  extremity, 
we  find  that  every  time  the  muscle  (Fig.  2,  m)  tends  to  contract,  there 
is  an  excitation  of  the  nerve  (n)  lying  upon  it,  and  a  contraction  of 
the  muscle  (m  2)  to  which  this  nerve  is  distributed.  Hence  it  is  not 
necessary  for  a  muscle  to  contract  in  order  to  produce  in  nerves  in 
contact  with  it  a  galvanic  excitation.  I  repeat  that  it  is  sufficient 
that  they  tend  to  contract.  Now,  I  have  found  that  the  greater  is 
the  resistance  to  the  contraction  of  a  muscle,  the  greater  is  the  gal- 
vanic excitation  that  it  gives  to  nerves  in  contact  with  its  tissue. 
On  the  contrary,  if  there  is  no  resistance  at  all,  as  already  shown 
by  Professor  Matteucci,  after  the  section  of  the  tendon,  then  the 
galvanic  excitation  of  nerves  in  contact  with  the  contracting  muscle 
no  longer  exists. 

If  we  compare  these  results  with  the  following  pathological  facts, 
we  find  that  the  phenomena  are  much  alike  in  the  two  series  of 
facts  that  we  compare,  and,  therefore,  that  they  seem  to  depend  on 
the  same  causes.  I  suppose  a  case  of  painful,  contracture  of  the 
anterior  muscles  of  the  thigh;  the  pain  is  increased  very  much 
every  time  the  contracted  muscles  are  elongated,  i.  e.,  when  the 
resistance  to  the  contraction  is  augmented ;  on  the  contrary,  it 
diminishes  when  the  resistance  to  the  contraction  is  rendered  less 
than  it  was,  and,  at  last,  it  disappears  entirely,  or  almost  entirely,  ichen 
the  resistance  is  completely,  or  almost  completely,  destroyed,  after  teno- 
tomy. Surgeons,  till  our  researches,  had  not  been  able  to  explain 
this  apparently  strange  cessation  of  pain ;  now  it  seems  quite  simple 
to  understand  that  such  should  be  the  case. 

In  cases  of  fissura  in  ano,  it  is  very  well  known  that  the  pain 
due  to  the  spasm  of  the  sphincter  is  increased  when  there  is  a  re- 
sistance to  the  contraction,  and  that  the  greater  the  elongation  of 
the  muscular  fibres,  the  greater  also  the  resistance  to  their  contrac- 
tion and  the  degree  of  pain.  At  last,  when  the  muscular  fibres 
can  contract  freely,  and  almost  without  resistance,  the  pain  disap- 
pears, as  is  the  case  after  the  operation  of  Boyer  (the  section  of  the 
sphincter).  Of  course  the  pain  depending  upon  the  fissure  persists, 
but  that  due  to  the  muscular  spasm  disappears.  In  this  case,  also, 
surgeons  could  not  explain  the  cessation  of  pain.     We  find  here, 


O  THE    CENTRAL    NERVOUS    SYSTEM. 

as  in  the  preceding  case,  that  the  excitation  of  the  nerves  due  to 
the  muscular  contraction  augments,  decreases,  and  disappears  in 
the  same  circumstances,  concerning  the  degree  or  the  absence  of 
resistance,  which  produce  analogous  phenomena  in  the  experiments 
above  mentioned. 

In  cases  of  neuralgia,  when  the  sensibility  of  nerves  in  muscles 
is  increased,  there  is  pain  produced  or  increased  every  time  the 
muscles  contract. 

The  contractions  of  the  uterus,  which  are  the  more  painful  the 
more  there  is  resistance  opposed  to  them,  cause  also  pain  in  the 
same  way  as  the  spasm  of  the  anus  or  the  contraction  of  the  mus- 
cles of  the  thigh.  The  relation  between  the  degree  of  contraction 
of  the  uterus  and  that  of  pain  is  so  evident,  that  the  word  "  pains" 
is  employed  for  that  of  "contraction." 

Every  muscular  contraction  seems  to  generate  a  galvanic  excita- 
tion of  the  sensitive  nerves  in  the  neighborhood  of  the  muscular 
fibres ;  and,  the  degree  of  excitation  being  in  proportion  to  the 
degree  of  energy  of  the  contraction,  we  have,  in  this  way,  an  excel- 
lent means  of  judging  of  the  state  of  the  muscles.  When  the  con- 
traction acquires  the  degree  which  it  has  in  cramps,  then  it  causes 
pain,  which  is  also  in  proportion  to  the  energy  of  the  spasm.  If 
we  succeed  when  we  have  a  cramp  in  making  it  cease  by  elongating 
the  contracted  muscle,  we  find  that  the  pain  often  increases  at  first, 
and  disappears  only  when  the  contraction  has  ceased.  I  regret  not 
to  be  able  to  bring  forward  all  the  reasons  which  have  led  me  to 
admit  the  views  I  have  just  proposed,  but  I  must  keep  within  my 
programme. 

If,  now,  we  examine  what  takes  place  in  the  apparently  para- 
doxical experiment  of  Magendie,  we  find  that  nothing  is  more 
easily  explained.  When  the  anterior  roots  of  a  spinal  nerve  are 
excited,  a  cramp  is  produced  in  the  muscles  in  which  the  nerve- 
fibres  of  the  roots  are  distributed,  and  the  pain  which  belongs  to  a 
cramj)  is  generated.  I  think  this  pain  is  due,  as  I  have  said  for 
cramps,  to  a  galvanic  excitation  of  the  sensitive  nerve-fibres  exist- 
ing in  the  muscles  which  contract;  but  whether  this  theory  be  true 
or  not  is,  in  a  measure,  indifferent  as  regards  the  general  cause  of 
pain  in  the  experiment  of  Magendie.  In  fact,  there  is  then  the  same 
cause  which  exists  in  a  cramp;  and  this  cannot  fail  to  be  so  inas- 
much as  a  real  cramp  is  generated  by  the  irritation  of  the  anterior 
roots.     So,  then,  we  can  conclude :  1st,  that  the  recurrent  sensation 


THEOEY  OF  SIE  CHAELES  BELL.  9 

is  only  in  appearance  recurrent ;  2d,  that  the  anterior  roots  of  the 
spinal  nerves  cause  pain  when  they  are  irritated,  because  they  pro- 
duce a  cramp :  3d,  that,  consequently,  there  is  no  sensibility  of  any 
kind  in  the  anterior  roots,  and  that  it  is  because  they  are  motor,  and  not 
because  they  are  sensitive,  that  they  cause  pain  ichen  they  are  irritated. 

Therefore,  the  objection  which  has  been  urged  against  the  views 
of  Sir  Charles  Bell,  and  which  was  founded  upon  the  fact  that 
the  anterior  roots  cause  pain  when  irritated,  is  unfounded.  "We 
will  now  say  a  few  words  of  the  objection  originating  from  the 
fact  that  there  are,  sometimes,  some  local  movements  when  the 
posterior  roots  are  excited.  These  local  movements  are  proved  to 
be  only  reflex  movements.  In  the  first  place,  there  is  no  contraction 
whatever  when  the  distal  part  of  a  posterior  root  is  irritated  ;  and, 
certainly,  if  there  were  motor  nerve-fibres  in  this  root,  contractions 
should  be  produced.  (See  Fig.  1,  d,  g)  In  the  second  place,  the 
irritation  of  the  central  part  of  a  divided  posterior  root  is  sometimes 
followed  by  local  contractions,  a  fact  which  implies  that  to  reach 
muscles,  the  irritation  passes  through  the  spinal  cord.  In  the  third 
place,  after  having  cut  the  anterior  roots  of  the  pair  of  nerves  of 
which  we  irritate  a  posterior  root,  we  do  not  see  any  local  contrac- 
tion following  this  irritation.  From  these  experiments  it  clearly 
results  that,  when  a  posterior  root  of  a  spinal  nerve  is  irritated,  if 
we  see  contractions  of  the  muscles  to  which  this  nerve  goes,  they 
arise  from  the  passage  of  the  excitation  to  the  spinal  cord,  and, 
from  thence,  to  the  muscles  through  the  anterior  roots.  In  other 
words,  we  must  admit  that  it  is  only  by  a  reflex  action  that  the 
posterior  roots  act  upon  muscles. 

It  would  seem  from  what  we  have  just  said,  and  from  the  explana- 
tion above  given  of  the  recurring  sensibility,  that  no  further  objection 
to  the  views  of  Sir  Charles  Bell  can  be  made;  but  this  is  not  the  case. 
J.  W.  Arnold1  has  tried  to  show  that  the  anterior  roots  of  nerves 
contain  the  nerve-fibres  which  convey  to  the  sensorium  the  impres- 
sions which  give  the  knowledge  of  the  state  of  the  muscles.  The 
chief  fact  on  which  he  grounds  his  opinion  is,  that  after  the  section 
of  the  posterior  roots  of  the  posterior  extremities  of  a  frog,  it  can 
make  use  of  its  hind  legs  almost  as  well  as  if  nothing  had  been  done 
to  the  posterior  roots.     This  experiment  is  certainly  of  some  value, 

1  Ueber  die  verrichtnng  des  Rneckenmarksnerven,  &c,  Heidelberg,  1845.  Ana- 
lyzed in  the  "British  and  Foreign  Medical  Review,"  April,  1845,  p.  558,  and  p. 
575. 


10  THE    CENTRAL    NEBVOUS    SYSTEM. 

and  we  must  acknowledge  that  it  is  difficult  to  explain  it  otherwise 
than  Arnold  has  done.  Moreover,  we  have  found  that,  after  the 
section  of  all  the  posterior  roots  of  the  spinal  nerves  in  frogs,  the 
voluntary  movements  seem  to  be  very  nearly  as  perfect  as  if  no 
operation  had  been  performed,  and  that  if  the  skin  of  the  head  is 
pinched  on  one  side,  the  posterior  limb  on  the  same  side  tries  to 
repel  the  cause  of  the  pain  as  well  as  if  no  injury  had  been  made. 
I  have  also  ascertained  that  in  frogs  rendered  blind,  these  experi- 
ments give  the  same  results. 

It  seems  very  probable,  from  these  facts,  that  there  is  at  least  a 
part  of  the  sensations  giving  to  the  mind  the  idea  of  the  state  of  a 
muscle,  which  passes  along  the  anterior  roots  to  go  to  the  senso- 
rium.  But,  although  I  agree  so  far  with  Arnold,  I  do  not  admit 
with  him  that  it  is  only  through  the  anterior  roots  that  impressions 
are  conveyed  from  the  muscles  to  the  brain.  When  a  galvanic 
current  is  applied  to  the  muscles  of  a  limb  of  a  frog,  on  which  the 
posterior  roots  of  the  nerves  of  this  limb  have  been  divided,  no 
trace  of  pain  is  produced,  and  all  the  other  causes  of  pain  are  also 
unable  to  cause  it,  when  applied  either  to  the  skin  or  to  the  mus- 
cles. When  I  examine,  in  another  lecture,  the  correlation  of 
pathological  cases  with  experimental  facts,  I  will  speak  again  of 
the  views  of  Arnold.  I  dismiss  actually  the  subject,  contenting 
myself  in  saying  that,  even  if  muscles  have  peculiar  nerve-fibres, 
which  go  up  to  the  brain  along  the  anterior  roots,  to  give  there 
some  special  sensations  in  correspondence  with  the  degree  of  con- 
traction, it  seems  nevertheless  quite  certain  that  the  nerves  of  touch 
and  those  which  convey  painful  impressions,  do  not  pass  by  the 
anterior  roots,  and  that,  therefore,  the  theory  of  Sir  Charles  Bell, 
as  regards  these  nerves,  remains  entire.  In  another  lecture  I  will 
show,  also,  that  all,  or  at  least  almost  all,  the  motor  nerve-fibres 
which  go  to  the  bloodvessels,  pass  in  the  anterior  roots. 

But,  if  Sir  Charles  Bell's  views  concerning  the  roots  of  nerves 
are  now  based  upon  irrefragable  experiments,  it  is  not  so  as  regards 
either  of  the  views  that  he  successively  proposed  concerning  the 
columns  of  the  spinal  cord.  We  will  prove  by  anatomical,  expe- 
rimental, and  pathological  facts,  that  his  ideas  concerning  the 
channels  for  sensation  and  volition  are  not  exact.  But,  at  the  same 
time  that  we  show  the  mistakes  he  has  committed  in  this  respect,  we 
will  bring  forward  a  great  many  proofs  of  a  theory  of  this  eminent 
physiologist,  which  is  by  far  of  greater  importance  than  the  views 


THEORY    OF    SIR    CHARLES    BELL.  11 

he  held  respecting  the  place  of  passage  of  the  sensitive  impressions, 
and  the  orders  of  the  will  in  the  spinal  cord.  The  great  theory  of 
Sir  Charles  Bell  was,  not  that  volition  and  sensation  have  their 
conductors  in  this  or  that  place,  but  that  these  conductors  are  dis- 
tinct one  from  the  other,  all  along  from  the  brain  to  the  periphery. 
It  is  this  principle  of  a  complete  distinction  between  the  elements 
of  the  nerves  and  of  the  spinal  cord,  which  are  employed  in  motion 
and  in  sensation,  which  is  the  great  thing  that  science  particularly 
owes  to  him.  Others  had  had  this  idea,  but  no  one  so  powerfully 
as  he  had;  and,  also,  no  one  tried  to  prove  it,  as  he  did.  But,  the 
principle  being  imagined,  it  remained  to  find  out,  first,  positive 
proofs  of  its  existence ;  and,  secondly,  whether  the  conductors — 
though  distinct  one  from  the  other — are  congregated  together  in 
the  same  sheath  (as  in  the  trunks  of  the  spinal  nerves),  or  are  sepa- 
rated in  distinct  bundles,  as  they  seem  to  be  in  the  roots  of  the 
spinal  nerves.  Now  we  must  say  that,  had  the  various  conductors 
been  everywhere  placed  in  contact  one  with  the  other,  the  theory 
could  not  have  been  proved.  As  regards  the  spinal  cord,  when  we 
began  our  researches,  the  most  positive  facts  amongst  those  that 
were  known,  seemed  to  be  quite  in  opposition  to  the  great  view  of 
Sir  Charles  Bell,  as  they  seemed  to  show  that  the  same  part  of  the 
spinal  cord  is  employed  both  in  voluntary  movements,  and  in  sen- 
sations. I  have  tried  to  show  that  the  same  conductors  cannot  be 
the  agents  for  both  voluntary  movements  arid  sensations,  inasmuch 
as  those  for  sensations  make  their  decussation  in  the  spinal  cord, 
whilst  those  for  motion  decussate  in  the  medulla  oblongata.  In  this 
respect,  then,  instead  of  being  in  opposition  to  the  great  principle, 
to  the  demonstration  of  which  Sir  Charles  had  employed  his  whole 
life,  I  have  brought  a  striking  fact  in  proof  of  the  truth  of  this 
principle.  But  I  repeat  that,  as  regards  the  channels  of  convey- 
ance of  the  sensitive  impressions  and  the  orders  of  the  will  in  the 
spinal  cord,  Sir  Charles  has  been  completely  mistaken.  This  will 
be  fully  demonstrated  hereafter. 

The  idea  first  proposed  by  Bell  was,  that  the  posterior  columns 
of  the  spinal  cord  are  the  continuations  of  the  posterior  roots,  and 
that  they  convey  the  sensitive  impressions  to  the  brain.  He 
thought  also  that  the  anterior  columns  convey  the  orders  of  the 
will  to  muscles.  This  theory  received  no  other  support  from 
its  author  than  the  following  attempt  at  experimenting,  which  we 
record  in  the  words  of  Sir  Charles:  "I  found  that  injury  to  the 


12  TIIE    CENTRAL    NERVOUS    SYSTEM. 

anterior  portion  of  the  spinal  marrow  convulsed  the  animal  more 
certainly  than  injury  to  the  posterior  portion ;  but  I  found  it  diffi- 
cult to  make  the  experiment,  without  injuring  both  portions."1 

The  theory  of  Sir  Charles  Bell  was  opposed  by  Bellingeri, 
Schoeps,  Kolando,  Calmeil,  Fodera,  and  several  others,  before  it 
found  a  very  ardent  supporter  in  Mr.  Longet.  All  the  experiment- 
ers which  we  have  just  named,  except  Mr.  Longet,  agreed  upon 
one  fact,  which  is,  that  a  section  of  the  posterior  columns  of  the 
spinal  marrow  is  not  followed  by  a  loss  of  sensibility.  Such  was 
the  state  of  science,  when  Longet  undertook  to  prove  that  the 
theory  of  Sir  Charles  Bell  concerning  the  columns  of  the  spinal 
cord,  was  as  exact  as  that  concerning  the  roots  of  the  spinal 
nerves.  In  the  next  lecture  we  will  show  how  Longet  has  been 
mistaken. 

1  The  Nervous  System  of  the  Human  Body.  By  Sir  Charles  Bell.  Third  edi- 
tion.    London,  1844.     Appendix,  p.  443. 


IS 


LECTURE    II. 

EXPERIMENTS  SHOWING  THAT  THE  TRANSMISSION  OF  THE  SENSITIVE 
IMPRESSIONS,  IN  THE  SPINAL  CORD,  TAKES  PLACE  CHIEFLY  IN  ITS  CEN- 
TRAL PART— i.  e.,  IN  THE  GRAY  MATTER. 

Experiments  and  views  of  Longet.  Objections  by  Dr.  R.  B.  Todd,  Mr.  Lockliart, 
Clarke,  and  the  Lecturer.  Causes  of  error  in  experimenting  upon  the  spinal 
marrow. — Experiments  proving  that  a  part  may  be  a  conductor  of  the  sensitive 
impressions,  though  not  endowed  with  sensibility. — Experiments  showing,  1st, 
that  a  transversal  section  of  the  posterior  columns  of  the  spinal  cord,  instead 
of  causing  anaesthesia,  is  followed  by  hypersesthesia  ;  2d,  that  a  transversal  sec- 
tion of  the  whole  spinal  cord,  except  the  posterior  columns,  is  followed  by  a 
complete  anaesthesia.  Anatomical  and  experimental  facts  showing  the  relative 
share  of  the  gray  matter,  and  of  the  various  columns  of  white  matter,  in  the 
transmission  of  the  sensitive  impressions. 

Mr.  President  and  Gentlemen:  Although  extremely  nume- 
rous, the  theories  concerning  the  transmission  of  the  sensitive 
impressions  in  the  spinal  cord  may  be  considered  as  mere  varieties 
of  two  principal  ones,  according  to  which  the  transmission  takes 
place  chiefly,  or  exclusively  in  the  posterior  columns,  or  in  the 
gray  matter.  Longet  is  the  principal  advocate  of  the  first  of  these 
two  theories.     He  thinks: — 

1st.  That  all  the  nerve-fibres  of  the  spinal  nerves  which  are  em- 
ployed in  the  transmission  of  the  sensitive  impressions,  enter  the 
posterior  columns  of  the  spinal  cord,  and  go  up  to  the  brain  in 
these  columns,  and,  therefore,  that  the  Sensorium  receives  sensitive 
impressions  only  from  these  parts  of  the  spinal  cord,  and  their  pro- 
longations in  the  encephalon. 

2dly.  That  in  the  medulla  oblongata,  the  restiform  bodies  being 
the  direct  continuations  of  the  posterior  columns  of  the  spinal  cord, 
are  also  the  only  channels  for  the  transmission  of  the  sensitive  im- 
pressions. 

3dly.  That  the  sensitive  impressions  going  to  the  sensorium  have 
to  pass  chiefly  across  the  cerebellum,  as  the  restiform  bodies  chiefly 
pass  across  this  organ. 


14  THE    CENTRAL    NERVOUS    SYSTEM. 

Longet  did  not  adduce  any  proof  of  the  correctness  of  this  theory. 
He  merely  tried  to  show  that  the  posterior  columns  of  the  spinal 
cord  are  the  only  parts  of  this  organ  which  are  sensitive — i.  e., 
which  cause  pain  when  irritated.  We  will  show  hereafter,  that, 
even  admitting  this  as  true,  it  was  wrong  to  draw  the  conclusion 
that  the  posterior  columns  are  the  only  conductors  of  sensitive  im- 
pressions. Before  we  pass  to  this  demonstration,  we  must  say,  as 
we  think  that  it  may  prove  useful  to  do  so,  that,  had  the  theory  of 
Longet  been  criticized,  even  in  taking  notice  only  of  the  facts  men- 
tioned by  this  physiologist,  it  would  have  been  easy  to  show  the 
utter  impossibility  of  admitting  this  theory ;  but  science  has  no 
critics,  and  this  imjwssible  doctrine  was  received  in  France  as  per- 
fectly demonstrated,  and  was  admitted  in  England,  by  almost  every 
one,  as  being  the  theory  of  Sir  Charles  Bell,  while  Sir  Charles  had 
already  repudiated  it,  five  or  six  years  before  the  first  publications 
of  Longet.  It  has  been  a  curious  spectacle  to  see  men  of  great 
learning  admitting  that  Longet  had  proved  the  truth  of  Sir  Charles 
Bell's  views,  while,  had  Longet  given  real  proofs,  he  would  have 
demonstrated  that  Sir  Charles  was  mistaken.  In  April,  1835,  Bell 
read  a  paper  before  the  Boyal  Society,1  in  which  he  says:  "Formerly 
I  believed  that  the  nerves  of  sensation — that  is  to  say,  the  posterior 
roots  of  the  spinal  nerves,  came  from  the  posterior  columns  of  the 
spinal  marrow,  and,  consequently,  from  the  cerebellum.  Whilst 
entertaining  this  belief,  I  found  my  progress  barred;  for  it  appeared 
to  me  incomprehensible  that  motion  could  result  from  an  organ 
like  the  cerebrum,  and  sensation  from  the  cerebellum,  for  there 
was  no  agreement  between  them.  They  conformed  neither  in  size, 
shape,  nor  subdivisions."  In  the  same  paper,  Sir  Charles  tries  to 
show  that  the  lateral  columns  of  the  spinal  marrow  must  be  the 
parts  transmitting  sensitive  impressions,  because  they  go  to  the 
cerebrum,  and  because  he  thought  that  the  posterior  roots  are 
united  with  them.  There  was,  therefore,  a  complete  disagreement 
between  Longet  and  Sir  Charles  Bell,  as  regards  the  function  of 
two  out  of  the  three  columns  of  the  spinal  cord — the  posterior  and 
the  lateral  columns. 

We  owe  to  Dr.  K.  B.  Todd  the  first  serious  objections  made  in 
England  against  the  views  of  Longet.2     These  objections  are  par- 

1  Philosophical  Transactions,  Part  I.,  1835;  and  "  The  Nervous  System  of  the 
Human  Body,"  by  Sir  Ch.  Bell,  third  edition,  1844,  pp.  238,  239. 

2  See  his  and  Mr.  Bowman's  admirable  work,  "  The  Physiological  Anatomy  and 


OBJECTIONS    TO    LONGET's    VIEWS.  15 

ticularly  grounded  upon  anatomical  and  pathological  facts.  Of 
these  last  facts  we  will  speak  elsewhere,  and  of  the  first  we  will  say 
that  they  relate — first,  to  the  size  of  the  posterior  columns,  which 
are  not,  as  they  should  be,  according  to  the  theory,  larger  and 
longer,  the  higher  they  are  examined  in  the  spinal  cord;  secondly, 
to  the  insertions  of  the  posterior  roots,  which  do  not  seem  to  be 
attached  to  the  posterior  columns. 

In  1851  and  1853,  Mr.  Lockhart  Clarke  published  his  important 
papers  "On  the  Structure  of  the  Spinal  Cord,"1  in  which  he  clearly 
showed,  as  Stilling  and  others  had  already  done,  that  the  posterior 
roots  of  nerves  are  in  continuation  with  the  gray  matter,  and  not 
with  the  posterior  columns ;  and  he  tried  to  show — as  had  been 
already  done  by  Sir  Charles  Bell  and  Dr.  Todd — that  the  posterior 
columns,  being  united  with  the  cerebellum,  could  not  be  considered 
as  the  only  conductors  of  the  sensitive  impressions. 

As  long  as  twelve  years  ago,  I  began  to  oppose  the  views  of 
Longet.2  I  shall  not  here  criticize  at  length  this  doctrine,  as  the 
very  arguments  which  I  shall  give  in  support  of  the  theory  that 
I  propose  will  be  found  easily,  and  without  my  showing  it,  to  be 
decisive  objections  to  the  views  of  Longet.  I  will  merely  try  to 
show  the  contradictions  which  exist  between  various  parts  of  the 
system  of  this  physiologist,  and  also  try  to  explain  how  he  has 
been  mistaken. 

1st  Contradiction. — Mr.  Longet  thinks  that  the  gray  matter  of  the 
spinal  cord  cannot  be  a  conductor  of  sensitive  impressions,  because 
it  is  not  endowed  with  sensibility ;  and  his  single  argument  to 
prove  that  the  posterior  columns  are  the  sole  conductors  of  the 
sensitive  impressions  is,  that  they  are  the  only  sensitive  parts  of 
the  spinal  cord.  On  another  side,  he  admits  that  the  cerebellum, 
which  he  rightly  believes  not  to  be  sensitive,  is  the  principal  chan- 
nel for  the  transmission  of  the  sensitive  impressions.  Of  course, 
if  the  gray  matter  of  the  spinal  cord  cannot  be  a  conductor,  be- 
cause it  is  not  sensitive,  the  cerebellum  also  cannot  be  a  conductor; 
and  if  it  is,  the  gray  matter  also  can  be. 

2d  Contradiction. — Longet  admits  that  the  extirpation  of  the  cere- 
Physiology  of  Man,"  Part  II.,  1845,  pp.  316-319;  and  the  article  "Nervous  Sys- 
tem," in  the  Cyclopaedia  of  Anatomy  and  Physiology. 

1  Philosophical  Transactions,  1851,  Part  II.,  p.  607,  and  1853,  Part  I.,  p.  347. 

2  See  my  Inaugural  Dissertation  for  the  Degree  of  M.  D. — Recherches  et  Exper. 
sur  la  Physiologie  de  la  Moelle  Epiniere.     Paris,  3  Janvier,  1846. 


16  THE    CENTRAL    NERVOUS    SYSTEM. 

bellum  does  not  diminish  the  sensibility  of  any  part  of  the  body, 
and  he  admits  also  that  the  cerebellum  is  the  principal  channel  of 
the  transmission  of  sensitive  impressions  to  the  brain. 

3d  Contradiction. — There  are  several  pathological  cases  mentioned 
by  Longet  which  show  that  an  alteration  of  a  lateral  half  of  the 
pons  Varolii  produces  a  complete  loss  of  sensibility  of  the  opposite 
half  of  the  body ;  Longet,  however,  admits  that  there  are  but  a 
small  number  of  the  sensitive  nerve-fibres  of  the  body  which  enter 
the  pons  Varolii.  On  another  side,  Longet  relates  pathological 
cases  showing  that  the  cerebellum  may  be  altered  very  deeply 
without  any  diminution  of  sensibility,  whilst  he  admits  that  most 
of  the  conductors  of  sensitive  impressions  pass  through  this  nerv- 
ous centre. 

4:th  Contradiction. — Longet  has  proposed  this  view :  that  the  pons 
Varolii  is  the  centre  for  the  perception  of  the  sensitive  impres- 
sions ;  and  he  admits  that  most  of  these  impressions  do  not  reach 
this  organ,  and  pass  through  the  cerebellum  going  up  to  the  brain. 

These  contradictions  are  certainly  sufficient  to  show  the  untena- 
bleness  of  the  systematic  views  of  Longet,  and  it  might  seem  use- 
less to  speak  any  more  of  these  views ;  but  as  they  have,  for  a  long 
while,  been  admitted  as  correct  by  almost  every  one  in  France  and 
in  England,  we  must  say  a  few  words  on  the  causes  of  the  errors 
committed  by  that  able  physiologist. 

There  are  two  means  of  ascertaining  by  experiments  the  func- 
tions of  a  nerve,  or  of  a  part  of  the  nervous  centres.  One  of  these 
means  consists  in  exciting  the  part,  and  in  finding  out  what  action 
takes  place  in  consequence  of  the  excitation;  the  other  consists  in 
a  section  or  the  extirpation  of  the  part,  and  in  examining  what  are 
the  actions  then  missing.  The  first  one,  therefore,  may  give  the 
action  of  a  part,  whilst  the  other  shows  what  is  its  action  when  we 
see  what  is  missing.  Of  these  two  means,  Longet  has  made  use  of 
the  first  one  only,  and  he  declares  that  it  is  impossible  to  employ 
the  second  on  the  spinal  cord.  We  shall  see,  on  the  contrary,  that 
the  first  one  could  not  be  employed  alone  with  success ;  whilst  the 
second  may  very  easily  be  employed,  and  furnish  positive  and 
direct  facts. 

Causes  of  Errors  in  experimenting  upon  the  Spinal  Cord. — Longet 
declares  that  it  is  impossible  to  lay  bare  the  spinal  cord  of  a  mam- 
mal without  producing,  at  once,  such  a  debility  in  the  posterior 
limbs  that  they  lose,  more  or  less  completely,  both  voluntary  move- 
ments and  sensibility.     Of  course,  if  mammals  were  always  in  this 


CHIEF    CONDUCTOR    OF    SENSITIVE    IMPRESSIONS.  17 

condition  after  the  opening  of  the  spinal  canal,  it  would  be  quite 
impossible  to  perform  any  valuable  experiment  on  the  spinal  cord, 
to  find  out  what  are  the  parts  employed  in  the  two  functions  which 
are  then  lost.  Fortunately,  animals  may  not  have  any  apparent 
diminution  of  either  voluntary  movements  or  sensibility  after  the 
exposure  of  the  spinal  cord  to  the  air.  They  may  walk  about  and 
run  as  fast  as  if  nothing  had  been  done  to  them,  and,  except  the 
little  change  in  the  movements  of  the  spine  due  to  the  section  of 
some  of  its  muscles,  no  difference  may  be  observed  between  them 
and  animals  which  have  not  been  operated  upon.  As  regards 
sensibility,  it  soon  becomes  increased,  as  I  have  stated  in  a  paper 
read  last  year  to  the  Royal  Society.  (See  "  Proceedings  of  the  Royal 
Society,"  1857,  No.  26.)  Longet  has  been  mistaken,  for  the  reason, 
that  he  opened  the  spinal  canal  in  a  considerable  portion  of  its 
length,  and  in  so  doing  produced  a  state  of  exhaustion  by  a  great 
loss  of  blood  and  by  the  excessive  pain.  When  the  operation  is 
made  quickly,  even  if  a  very  considerable  part  of  the  cord  is  laid 
bare,  if  the  haemorrhage  has  not  been  great  and  if  pain  has  been 
avoided  by  the  exhibition  of  chloroform,  there  is  no  notable  dimi- 
nution of  sensibility,  and  there  is  no  other  diminution  in  the  volun- 
tary movements,  except  that  depending  upon  the  section  of  the 
muscles  of  the  back.1 

Another  cause  of  error  committed  by  some  experimenters  was  in 
thinking  that  the  absence  of  sensibility  in  the  gray  matter  of  the  spi- 
nal cord  is  a  proof  that  this  matter  is  not  a  conductor  of  the  sensitive 
impressions.  A  distinction  between  the  property  of  conduction  or 
transmission,  and  the  property  of  being  sensitive  or  impressionable, 
would  have  prevented  such  a  mistake.  The  nerve-fibres  of  the 
cerebral  lobes  are  conductors,  but  they  are  not  excitable,  not  impres- 
sionable; and  so  is  the  gray  matter  of  the  spinal  cord;  when  it  exists 
alone,  establishing  the  communication  between  two  parts  of  the 
spinal  cord,  after  a  transversal  section  of  the  whole  of  the  white 

1  Animals  usually  survive  after  the  laying  bare  of  the  spinal  cord,  while  they 
usually  die  after  the  laying  hare  of  the  brain.  Indeed,  if  the  susceptibility  to  in- 
flammation is  not  greater  in  the  spinal  cord  and  its  membranes  in  man  than  in 
animals,  I  think  that  Clive,  Tyrrell,  Laugier,  and  others,  who  have  applied  the 
trephine  to  the  spine  after  fractures,  should  have  imitators.  In  dogs,  I  have  ascer- 
tained that  the  fracture  of  the  posterior  part  of  the  vertebrae  causes  death,  unless 
the  broken  pieces  be  removed  and  the  effused  liquid  evacuated.  Even  in  adult 
animals,  the  pieces  of  bone  taken  away  are  usually  reproduced  in  a  few  months, 
and  the  injured  spinal  cord  may  also  recover  its  functions. 

B 


18  THE    CENTRAL    NERVOUS    SYSTEM. 

matter,  it  conducts,  it  transmits  to  the  brain  the  sensitive  impressions 
made  on  impressionable  organs  behind  the  section,  but  when  irritated 
it  does  not  transmit  anything  because  it  is  not  itself  impressionable. 
I  have  found  that  even  the  most  sensitive  nerve  in  the  body,  the  tri- 
geminal, loses  its  sensibility,  its  impressibility,  in  a  part  of  its  length. 
It  is  well  known  that  a  very  considerable  root  of  the  trigeminal  nerve 
goes  down  in  the  medulla  oblongata  towards  the  nib  of  the  calamus 
scriptorius,  being  there  between  the  anterior  pyramid  and  the  resti- 
form  body.  Magendie  has  shown  that  a  transversal  section  of  one- 
half  of  the  medulla  oblongata  dividing  this  root  causes  the  loss  of 
sensibility  of  the  face,  so  that  this  root  is  positively  a  channel  for 
the  transmission  of  the  sensitive  impressions  to  the  sensorium. 
Now,  I  have  found  that  if  a  pin  (even  a  large  one)  be  introduced 
slowly  and  perpendicularly  (see  Fig.  5,  p)  through  the  restiform 
body  and  the  root  of  the  trigeminal  nerve  in  the  medulla  oblongata, 
there  is  no  sign  of  pain,  so  that  the  impressibility  of  this  root  in 
that  part  of  its  length  is  lost,  or  at  least  notably  diminished.  This 
fact  proves  that  the  power  of  conducting  sensitive  impressions  may 
exist  in  parts  deprived  of  sensibility.  Even  when  we  compare  the 
various  parts  of  the  length  of  the  roots  and  of  the  trunk  of  the 
spinal  nerves,  from  the  skin  to  the  spinal  cord,  we  find  great  differ- 
ences in  the  degree  of  sensibility,  while  the  conducting  power  seems 
to  be  the  same  everywhere.  (See  my  paper  on  this  subject  in  my 
work,  Experimental  Researches  applied  to  Physiology  and  Pathology, 
1853,  p.  98.) 

Of  the  means  of  experimenting,  of  which  we  have  already  spoken,- 
the  one  which  consists  in  employing  excitations  is  certainly  un- 
able to  give  any  decisive  result,  as  regards  the  question  of  the 
channel  by  which  the  sensitive  impressions  are  conveyed  to  the 
brain,  in  the  spinal  cord.  All  that  may  legitimately  be  deduced 
from  the  effects  of  the  excitation  of  the  various  parts  of  the  spinal 
cord  is,  that  a  certain  part  is  sensitive,  or  seems  to  be,  while  others 
seem  not  to  be.  Another  cause  of  error  exists  when  we  try  to  find 
out  if  a  part  is  sensitive  or  not.  If  galvanism  is  employed,  as  was 
the  case  in  the  experiments  of  Longet,  it  is  indeed  impossible  to 
have  a  current  applied  to  the  posterior  columns,  which  will  not 
pass  by  the  posterior  roots,  and  as  the  sensibility  of  the  roots,  par- 
ticularly at  the  place  where  they  are  in  connection  with  the  spinal 
marrow,  is  excessive,  the  signs  of  pain  given  by  the  animals  do  not 
prove  that  the  posterior  columns  are  sensitive.  Experiments  in 
which  an  irritation  is  made  with  the  point  of  a  needle  or  a  pin  may 


CHIEF    CONDUCTOR    OF    SENSITIVE    IMPRESSIONS.  19 

be  considered  as  insufficient,  because  the  degree  of  pain,  then,  is  not 
very  great.  However,  so  far  as  we  may  draw  conclusions  from  this 
kind  of  experiment,  it  seems  very  doubtful  whether  the  posterior 
columns  possess  any  sensibility,  and  the  causes  of  the  mistake 
which  has  been  made  in  this  respect  are,  that  the  posterior  roots 
have  been  irritated,  and  that  the  excitability  for  reflex  action  is 
very  great  in  the  posterior  columns,  and  the  movements  due  to  the 
reflex  faculty  have  been  considered  as  signs  of  pain.1 

I  pass  now  to  the  exposition  of  the  facts  upon  which  I  ground 
the  theory  I  have  proposed  concerning  the  channels  of  transmis- 
sion of  sensitive  impressions. 

The  first  fact  I  have  to  speak  of  is,  that  a  transversal  section  of 
the  posterior  columns,  instead  of  being  followed  by  the  loss,  or 
even  a  diminution,  of  sensibility,  seems  to  produce  an  increase  in 
the  amount  of  this  property ;  in  other  words,  I  have  found  that  the 
section  of  these  pretended  only  channels  of  the  sensitive  impres- 
sions, instead  of  preventing  them  from  passing,  allows  them,  on 
the  contrary,  to  pass  more  freely,  so  that  instead  of  anaesthesia  there 
is  hyperesthesia.  In  certain  animals,  and  especially  in  rabbits  and 
sheep,  it  is  very  easy  to  ascertain  that  there  is  a  very  great  increase 
in  sensibility  in  the  various  parts  behind  the  section.  Before  the 
operation,  in  rabbits,  the  most  energetic  pinching  of  the  skin  pro- 
duces agitation,  but  no  shrieking;  after  the  operation,  on  the  con- 
trary, the  least  pinching  produces  shrieking,  and  a  much  greater 
agitation.  Sometimes  the  hyperesthesia  is  so  considerable  that  the 
least  pressure  upon  the  skin  makes  the  animal  shriek.  Whether 
the  operation  is  performed  in  the  lumbar,  the  dorsal,  or  the  cervical 
region,  the  phenomena  are  always  the  same;  that  is,  there  is  a 
manifest  hyperesthesia  in  the  various  parts  of  the  body  which  re- 
ceive their  nerves  from  the  part  of  the  spinal  cord  which  is  behind 
the  section.     It  has  been  so  in  all  the  animals  I  have  operated  upon, 

1  Although,  the  reflex  excitability  of  the  posterior  columns  of  the  spinal  cord  is 
very  great,  the  reflex  movements  observed  when  we  irritate  these  columns  alone, 
in  a  decapitated  animal,  are  not  so  powerful  as  when  we  irritate  at  the  same  time 
the  posterior  roots  and  the  posterior  columns.  But  whatever  may  be  admitted 
concerning  this  difference,  it  is  quite  certain,  as  first  pointed  out  by  the  learned 
translator  of  Miiller  (Physiol.,  p.  796),  Dr.  Baly,  that  the  irritation  of  the  posterior 
columns  of  the  spinal  cord  produces  more  movement  than  the  excitation  of  the 
anterior  columns.  In  cases  of  tumours  pressing  upon  the  spinal  cord  there  is  also 
more  spasmodic  action  when  the  pressure  is  on  the  posterior  than  when  it  is  on 
the  anterior  columns. 


20  THE    CENTRAL    NERVOUS    SYSTEM. 

and  I  have  already  made  this  experiment  upon  animals  belonging 
to  more  than  twenty  species. 

As  long  as  the  animals  live  after  the  section  of  the  posterior 
columns,  hyperesthesia  continues  to  exist,  except  in  the  cases  where 
reunion  takes  place  between  the  two  surfaces  of  the  section ;  but 
hyperesthesia  is  greater  during  the  first  week  after  the  operation 
than  it  is  after  a  month  or  many  months. 

Laying  aside  the  curious  fact  of  the  existence  of  hyperesthesia,  a 
fact  which  is  observed  also  in  man,  when  the  posterior  columns  of 
the  spinal  marrow  are  altered  or  injured,  in  a  small  part  of  their 
length,  it  results  from  the  experiments  consisting  in  a  transverse 
section  of  these  columns  that  the  transmission  of  sensitive  impres- 
sions to  the  encephalon  does  not  take  place  only  along  the  posterior 
columns.  If  a  complete  transverse  section  is  made  upon  any  part 
of  the  restiform  bodies,  sensibility  becomes  very  much  increased  in 
every  part  of  the  limbs  and  trunk. 

Hyperesthesia  is  also,  but  in  a  less  degree,  one  of  the  results  of 
a  transversal  incision  in  the  cerebellum,  in  the  processus  cerebelli 
ad  testes,  and  in  the  tubercula  quadrigemina. 

If  we  carefully  dissect  the  two  restiform  bodies  so  as  to  separate 
them  from  the  neighboring  parts,  and  if  we  divide  them  trans- 
versely at  their  two  extremities,  and  then  remove  them,  we  find 
that  the  animal,  instead  of  losing  its  sensibility  in  the  different  parts 
of  the  limbs  and  trunk,  becomes  hyperesthetic. 

It  results  from  these  experiments,  that  the  restiform  bodies,  which 
are  the  direct  continuations  of  the  posterior  columns  of  the  spinal 
cord,  are  not  the  only  channels  for  the  transmission  of  sensitive 
impressions  to  the  sensorium. 

It  seems  certain,  therefore,  that  the  posterior  columns  of  the  spinal 
cord  and  of  the  medulla  oblongata  are  not  the  only  channels  for  the  trans- 
mission of  the  sensitive  impressions  from  the  limbs  and  trunk  to  the  sen- 
sorium. 

But  we  can  go  farther,  and  prove  that  the  posterior  columns  do 
not  seem  to  transmit  the  least  part  of  the  sensitive  impressions  to 
the  encephalon. 

I  have  ascertained  that  after  almost  a  complete  transverse  section 
of  the  spinal  cord,  leaving  undivided  only  the  posterior  columns, 
the  transmission  of  sensitive  impressions  from  almost  all  the  parts 
of  the  body  behind  the  section  does  not  take  place.  This  experi- 
ment, performed  by  Stilling  almost  exclusively  upon  frogs,  led  him 
to  affirm  that  sensibility  is  then  entirely  lost  in  all  the  parts  behind 


CHIEF    CONDUCTOR    OF    SENSITIVE    IMPRESSIONS.  21 

the  section.  Much  more  recently,  M.  Schiff,  repeating  this  experi- 
ment, found,  on  the  contrary,  that  sensibility  is  not  lost  in  any  of 
the  various  parts  behind  the  section.  Messrs.  Vulpian  and  Phili- 
peaux,  who  made  this  experiment  some  time  after  Schiff,  positively 
declare  that  sensibility  is  completely  and  definitely  lost.  I  have 
ascertained  that  the  differences  in  the  results  of  this  experiment  de- 
pend upon  various  circumstances.  At  first,  if  the  least  quantity  of 
the  central  gray  matter  of  the  spinal  cord  is  left  undivided,  sensi- 
bility persists  (although  much  diminished)  almost  everywhere  be- 
hind the  section.  Besides,  there  are  parts  in  the  neighborhood  of 
the  section,  and  behind  it,  which  always  remain  sensitive.  I  will 
explain  afterwards  what  is  the  cause  of  this  partial  persistence  of 
sensibility.  Whatever  is  this  cause,  if  we  perform  the  following 
experiment,  we  may  obtain  the  most  decisive  results:  The  spinal 
cord  having  been  laid  bare  in  a  large  mammal,  in  the  dorsal  region, 
I  divide  transversely  the  whole  of  it,  except  only  the  two  posterior 
columns  (see  Fig.  8,  d),  and,  after  ten  or  fifteen  minutes,  or  a  little 
more,  I  find  that  all  the  usual  means  of  exciting  pain  are  applied 
in  vain  to  the  posterior  limbs,  so  that  these  parts  seem  to  be  entirely 
deprived  of  sensibility.  It  results  from  this  experiment,  and  from 
many  others,  in  which  the  section  was  made  nearer  to  the  medulla 
oblongata,  that  the  sensitive  impressions  do  not  pass  along  the  pos- 
terior columns  in  their  way  to  the  encephalon. 

If  the  transmission  of  sensitive  impressions  does  not  take  place 
along  the  posterior  columns,  it  remains  to  be  found  what  is  the 
channel  of  this  transmission.  Is  it  the  gray  matter  or  some  part  of 
the  lateral  or  anterior  columns,  or  all  or  several,  of  these  constitu- 
ents of  the  spinal  cord?  As  regards  the  lateral  columns,  if  we 
divide  them  transversely  in  the  dorsal  region,  we  find  that  sensi- 
bility, instead  of  being  lost,  seems  to  be  increased  in  the  two  pos- 
terior limbs.  But  if,  in  performing  this  experiment,  the  knife  goes 
farther  than  the  limits  of  the  lateral  columns,  and  divides  a  part  of 
the  central  gray  matter  on  the  two  sides,  sensibility  is  then  dimi- 
nished in  the  two  posterior  limbs.  From  these  experiments,  and 
from  another  one,  which  consists  in  a  transverse  section  of  the 
whole  spinal  cord  except  one  of  the  lateral  columns,  it  results  that 
these  columns,  like  the  posterior,  are  not  the  channels  of  transmis- 
sion of  any  part  of  the  sensitive  impressions  to  the  encephalon. 

It  is  not  so  with  regard  to  the  gray  matter,  as  the  following  ex- 
periments show: — 

1st.  A  transversal  section  of  the  whole  posterior  half  of  the  spinal 


99 


THE    CENTRAL    NERVOUS    SYSTEM. 


cord  is  made,  in  the  dorsal  region,  so  that  the  posterior  columns 
and  the  posterior  half  of  the  lateral  columns  and  of  the  gray  matter 
are  divided,  and  then  sensibility  is  found  diminished  in  the  two 
posterior  limbs.  Of  course  we  cannot  attribute  this  diminution  to 
the  section  of  the  posterior  or  of  the  lateral  columns,  as  we  know 
that  these  divisions  cause  an  increase  of  sensibility,  and  not  a  dimi- 
nution. 

2d.  A  transversal  section  of  the  whole  anterior  half  of  the  spinal 
cord,  in  the  dorsal  region,  is  made,  so  that  the  anterior  columns  and 
the  anterior  half  of  the  lateral  columns  and  of  the  gray  matter  are 
divided,  and  then  sensibility  is  found  diminished  in  the  two  pos- 
terior limbs.  \V~e  cannot  attribute  this  diminution  to  the  section 
of  a  part  of  the  lateral  columns,  as  we  know  that  such  an  injury  to 
the  cord  would  increase,  and  not  diminish,  sensibility;  nor  can  we 
admit  that  the  section  of  the  anterior  columns  is  the  only  cause  of 
diminution  of  sensibility,  as,  when  these  columns  are  alone  divided, 
there  is  no  marked  alteration  of  sensibility. 

3d.  If  the  anterior,  the  lateral,  and  the  posterior  columns  of  the 
spinal  cord  are  divided  transversely,  at  the  dorsal  region,  one  set  at 
one  place,  another  at  a  distance  of  one  or  two  inches,  and  the  third 
also  at  the  same  distance  from  the  second,  so  that  the  only  channel 
of  communication  between  the  posterior  limbs  and  the  sensorium 
is  the  gray  matter,  of  which,  however,  several  parts  have,  unavoid- 
ably, been  divided  (such  as  the  anterior  and  the  posterior  gray 
cornua,  and  also  more  or  less  of  the  central  gray  matter),  we  find 
that  the  posterior  limbs  are  still  sensitive,  though  evidently  less 
than  in  the  normal  condition. 

4th.  If  the  section  is  made  so  as  to  divide  only  a  small  part  of 
one  of  the  lateral  columns,  and  almost  the  whole  of  the  gray  matter, 
sensibility  is  very  much  diminished  in  the  parts  of  the  body  behind 
the  section. 

These  facts  prove  that  the  gray  matter  is  the  principal  conductor 
of  the  sensitive  impressions  in  the  spinal  cord. 

But,  amongst  the  white  columns,  there  are  some,  besides  the  pos- 
terior ones,  which  have  been  considered,  by  two  or  three  physio- 
logists, as  organs  of  transmission  of  the  sensitive  impressions;  I 
mean  the  anterior  columns.  Calmeil  and  Xonat  thought  that 
these  parts  share  in  this  function.  Although  I  admit  their  view, 
I  believe  they  were  mistaken  in  their  experiments,  which  consisted 
in  a  transversal  section  of  the  whole  spinal  cord,  except  the  ante- 
rior columns,  as  they  state  that  immediately,  or  shortly  after  the 


CHIEF    CONDUCTOR    OF    SENSITIVE    IMPRESSIONS.  23 

operation,  they  found  sensibility  persisting.  This  is  not  the  case 
when  the  whole  of  the  gray  matter  has  been  cut  transversely,  and 
it  is  extremely  probable  that  they  had  left  a  good  part  of  it  undi- 
vided. But  if  the  operation  be  made  so  as  to  leave  no  gray  matter 
at  all,  sensibility,  which  at  first  seems  to  be  lost,  after  a  time  reap- 
pears, and  many  hours  after,  it  evidently  exists  everywhere,  though 
in  a  slight  degree  only.1  It  is  evident,  therefore,  that  the  anterior 
columns  have  a  share,  but  only  a  small  one,  in  the  transmission  of 
the  sensitive  impressions  to  the  sensorium. 

From  all  the  facts  above  related,  it  results  that  the  transmission 
of  sensitive  impressions  takes  place  chiefly  by  the  gray  matter, 
and,  for  a  small  part  only,  by  the  anterior  columns,  while  the  lateral 
and  the  posterior  columns  do  not  participate  in  the  same  way  as 
the  preceding  parts  of  the  cord,  in  this  function.  We  shall  see,  in 
a  moment,  that  they  have  a  peculiar  kind  of  share  in  this  trans- 
mission. 

Which  part  of  the  gray  matter  is  employed  in  the  transmission  of 
sensitive  impressions  t  This  substance  is  composed  of  parts  surround- 
ing the  central  canal  of  the  cord,  of  lateral  masses,  and  of  two 
anterior  and  two  posterior  horns,  which  separate  the  lateral  columns 
from  the  anterior  and  the  posterior  ones.  I  call  central  gray  matter 
the  lateral  masses,  the  bases  of  the  anterior  and  posterior  horns, 
and  all  the  substance  around  the  central  canal,  and  I  think  that  the 
transmission  of  the  sensitive  impressions  takes  place  chiefly  by  this 
central  gray  matter.  As  regards  the  anterior  horns  of  gray  matter, 
I  am  not  prepared  to  affirm  that  they  have  no  share  at  all  in  this 
function;  but  I  may  state  the  posterior  horns  do  not  participate  in 
it,  in  the  same  way  as  the  central  portion  of  gray  matter. 

Which  elements  of  the  central  gray  matter  are  employed  in  the 
transmission  of  sensitive  impressions?  This  difficult  question  has 
not  yet  received  a  positive  solution;  but  it  cannot  be  doubted, 
at  least,  that  the  transmission  takes  place  by  both  cells  and  nerve- 
fibres  united  together,  and  not  by  cells  alone  acting  at  a  distance 
upon  their  neighbors.  Most  of  the  nerve-fibres  of  the  roots  of 
the  spinal  nerves,  after  having  reached  the  gray  matter,  attach 
themselves  to  the  nerve-cells,  and,  as  has  been  well  demonstrated 
by  K.  Wagner,  and  by  Bidder,  and  several  of  his  pupils,  these  cells 
communicate  with  others  in  such  a  way  that  two  kinds  of  transmis- 
sion are  possible,  one  across  the  cord,  and  another  towards  or  from 

1  See  my  paper  in  the  "Proceedings  of  the  Royal  Society,"  No.  26,  1357. 


24  THE    CENTRAL    NERVOUS    SYSTEM. 

the  encephalon.  But,  besides  the  nerve-cells  and  their  nervous 
fibrils  of  communication,  there  are,  in  the  gray  matter,  several  col- 
lections of  longitudinal  nerve-fibres,  forming  very  minute  white 
columns,  surrounded  by  the  gray  substauce.  These  white  columns, 
first  well  described  by  Mr.  Lockhart  Clarke,  and,  after  him,  by  Prof. 
Schrceder  van  der  Kolk,  cannot  be  considered  as  the  only  channels, 
in  the  gray  matter,  for  the  sensitive  impressions  or  for  the  orders 
of  the  Will  to  muscles.  The  number  of  fibres  they  contain  is  too 
small  for  them  to  have  these  functions  alone,  but  it  is  probable  that 
they  participate  -in  it.  Are  they  emplo}*ed  for  a  peculiar  kind  of 
sensitive  impressions  while  the  other  impressions  would  be  trans- 
mitted by  nerve-cells  and  their  communications?  This  is  a  ques- 
tion that  experiments  upon  animals  cannot  solve.  We  will  speak 
of  it  again  when  we  give  the  history  of  the  pathological  cases  re- 
lating to  the  subjects  discussed  here. 

We  must  now  examine  if  the  posterior  and  lateral  columns  have 
not  a  peculiar  share  in  the  transmission  of  sensitive  impressions. 
As  regards  the  posterior  columns,  the  following  experiments  will 
show  that  there  are  conductors  of  sensitive  impressions  passing 
through  them.  Long  ago  I  found  that  after  a  transversal  section 
of  the  columns,  the  inferior  surface  of  the  section,  that  which  seems 
no  more  to  be  connected  with  the  encephalon,  appears  to  be  highly 
sensitive.  I  have  since  ascertained  that  the  posterior  roots  in  the 
neighborhood  of  that  surface  are  the  parts  which  then  give  the 
sensation  of  pain.  But  whether  sensibility  exists  only  in  the  roots 
or  in  the  fibres  of  the  posterior  columns,  it  is  a  fact  that  pain  is 
produced  when  this  inferior  surface  is  irritated.  In  1852,  I  was 
led  still  more  to  admit  that  there  are  nerve-fibres  coming  from  the 
posterior  roots,  and  passing  in  two  opposite  directions  in  the  poste- 
rior columns  (see  the  arrows  in  Fig.  6),  some  going  upwards  and 
some  going  downwards,  or,  in  other  words,  some  going  direct 
towards  the  encephalon  and  some  going  away  from  it.  The  follow- 
ing experiment  was  the  first  which  led  me  to  the  conclusion  that 
there  are  fibres  of  the  posterior  roots  descend ing  in  the  posterior 
columns:  I  introduced  a  very  sharp  bistoury  between  the  posterior 
and  the  anterior  parts  of  the  spinal  cord,  and  by  cutting  from  above 
downwards,  or  in  the  opposite  direction,  I  separate  a  part  of  the 
length  of  the  posterior  columns  of  the  cord  from  the  anterior  parts 
of  this  organ.  This  being  done,  I  divide  transversely  and  in  its 
middle  the  part  of  the  posterior  columns  separated  from  the  ante- 


ASCENDING    AND    DESCENDING    CONDUCTOKS.  25 

rior  parts  of  the  spinal  cord, g  so  as  to  obtain  (see  Fig.  6)  two  seg- 
ments, one  superior,  the  other  inferior.  The  superior  I  will  call 
cephalic  segment,  and  the  other  caudal  segment.  Now,  when  there 
are  some  little  parts  of  the  posterior  gray  horns  and  some  fibres  of 
the  posterior  roots  attached  to  these  segments,  we  obtain  this  ap- 
parently strange  and  surely  unforeseen  result,  that  not  only  the 
caudal  segment  is  sensitive,  but  that  it  seems  to  be  more  sensitive 
than  the  cephalic  segment.  But  whatever  may  be  the  real  amount 
of  sensibility  in  these  two  segments,  there  is  one  capital  conclusion 
to  be  drawn  from  this  experiment,  and  this  is,  that  a  number  of  the 
conductors  of  sensitive  impressions  in  the  posterior  roots  pass  in  the  pos- 
terior columns,  in  ivhich  some  go  upwards  towards  the  encephalon  [cen- 
tripetal or  ascending  fibres),  while  others  go  in  the  opposite  direction — i.  e., 
dowmuards  or  bacJcivards  (centrifugal  or  descending  fibres). 

Now  the  question  arises —  What  become  of  these  ascending  and  de- 
scending conductors?  By  a  great  many  experiments  of  various  kinds, 
I  have  ascertained  that  they  pass  along  the  posterior  columns  only 
a  little  way,  and  leave  them  to  enter  the  central  gray  matter.  I 
will  relate  a  few  of  the  most  striking  experiments,  which  prove  that 
such  is  truly  the  disposition  of  these  conductors.  If,  after  having 
ascertained  that  the  roots  attached  to  the  upper  or  cephalic  segment 
(see  Fig.  6)  are  sensitive,  I  divide  transversely  the  posterior  columns 
at  a  very  short  distance  above  the  extremity  of  the  segment,  I  find 
that  it  loses  its  sensibility,  which  fact  shows  that  the  transmission 
takes  place  by  these  columns.  Now  if  the  section  is  made  higher, 
sensibility  persists,  though  diminished,  showing  that  some  of  the 
conductors  must,  at  this  distance,  have  left  the  posterior  columns 
and  entered  another  part  of  the  cord;  at  last,  if  the  section  is  made 
far  above  the  extremity  of  the  segment,  sensibility  persists  entire 
in  the  roots  attached  to  that  extremity,  which  shows  that  the  con- 
ductors, at  a  certain  distance  from  the  point  of  their  entrance  into 
the  posterior  columns,  leave  these  columns  to  pass  into  another 
part  of  the  cord.  This  part  is  the  central  gray  matter,  as  is  proved 
by  the  fact  that  if  we  divide  it  transversely  at  four  or  five  inches 
above  the  cephalic  segment,  this  segment  loses  its  sensibility. 

With  the  inferior,  or  caudal  segment,  analogous  experiments 
show  that  the  conductors  coming  from  the  posterior  roots  descend 
in  the  posterior  columns,  and,  after  a  very  short  distance,  pass  into 
the  central  gray  matter.  There  the  transmission  takes  place 
towards  the  encephalon ;  so  that  there  are  recurrent  conductors  in 
the  spinal  cord. 


26  THE    CENTRAL    NERVOUS    SYSTEM. 

An  excellent  experiment,  showing  the  share  of  the  gray  matter 
in  the  transmission  of  sensitive  impressions  may  be  made  after  we 
have  prepared  two  segments  of  the  posterior  columns,  as  we  have 
said  already.  We  ascertain  that  the  caudal,  or  lower  segment,  is 
very  sensitive,  and  then  we  divide  gradually  the  laid-bare  gray 
matter  (see  Fig.  6,  g\  and  we  find  that  gradually,  also,  sensibility 
disappears  in  this  segment. 

Experiments,  which  it  is  useless  to  describe,  seem  to  show  also 
that  there  are  some  fibres  from  the  posterior  roots  which  ascend, 
and  others  which  descend,  in  the  lateral  columns,  and  in  the  posterior 
horns,  both  of  which  soon  reach  the  central  gray  matter,  by  which 
part  the  transmission  to  the  encephalon  is  at  last  performed. 

Their  existence  in  the  posterior  columns,  and  also  probably  in  the 
posterior  horns  and  a  part  of  the  lateral  columns,  receives  additional 
evidence  from  the  following  experiment:  If  the  posterior  half  of 
the  spinal  cord  is  divided  in  two  places,  in  one  case  very  near,  and 
in  another  very  far,  one  from  the  other  (see  Fig.  7),  we  find  that 
there  is  a  loss  of  sensibility  in  the  posterior  roots  which  are  be- 
tween the  two  sections,  when  they  are  very  near  one  to  the  other ; 
while,  on  the  contrary,  sensibility  remains,  and  seems  to  be  in- 
creased, in  the  posterior  roots  which  are  between  the  two  sections, 
when  they  are  at  a  great  distance  one  from  the  other.  In  admitting 
that  before  reaching  the  central  gray  matter  the  fibres  of  the  poste- 
rior roots  go  up  and  down  the  cord  along  the  posterior  columns, 
and  along  the  parts  (gray  or  white)  which  are  in  the  neighborhood 
of  these  columns,  and  which  have  been  divided  with  them,  we  have 
the  explanation  of  the  loss  of  sensibility  in  the  first  case ;  and  in 
admitting  that  these  conductors,  after  a  short  distance,  enter  the 
central  gray  matter,  we  explain  the  persistence  of  sensibility  in  the 
second  case. 

With  this  knowledge  of  the  mode  of  distribution  of  the  sensitive 
conductors  in  the  spinal  cord,  we  may  explain  the  differences  in  the 
results  arrived  at  by  different  experimenters  after  the  operation 
consisting  in  a  transversal  section  of  the  totality  of  the  spinal  cord, 
except  the  posterior  columns.  If,  for  instance,  this  operation  has 
been  made  at  the  level  of  the  second  or  third  lumbar  vertebrae,  very 
little  above  the  place  where  the  roots  of  the  nerves  going  to  the  ab- 
dominal limbs  begin  to  originate,  we  find  that  the  extremities  of 
these  limbs  seem  to  be  completely  deprived  of  sensibility,  but  that 
when  the  upper  parts  of  the  limbs  are  irritated,  there  are  evident 


ASCENDING    AND    DESCENDING    CONDUCTORS.  27 

signs  of  sensibility.  The  reason  of  this  difference  is  obvious,  if  we 
admit  that  the  fibres  from  the  roots  of  the  nerves  going  to  the  ex- 
tremities of  the  limbs  leave  the  posterior  columns  of  the  spinal  cord 
below  the  section,  and  pass  into  the  gray  matter,  and,  also,  in  the 
anterior  columns,  which  parts  are  divided;  while  some  of  the  fibres 
from  the  roots  of  the  nerves  going  to  the  upper  parts  of  the  limbs, 
pass  into  the  posterior  columns  at  the  level  where  the  other  parts 
of  the  cord  are  divided,  and  still  transmit  the  sensitive  impressions. 
To  prove  that  they  pass  only  a  short  way  in  and  along  the  poste- 
rior columns,  I  have  performed  the  following  additional  experi- 
ment. In  one  case  I  divide  transversely  the  posterior  columns  at 
a  very  short  distance  above  the  place  where  the  antero-lateral  parts 
of  the  cord  have  been  cut,  and  I  find,  then,  that  sensibility  is  entirely 
lost  in  all  the  parts  of  the  posterior  limbs  (see  Fig.  8,  d,  s),  in  the 
other  case  I  divide  transversely  the  posterior  columns  at  a  great 
distance  from  the  other  section,  and  I  find  that  sensibility  of  the 
upper  parts  of  the  posterior  limb  persists. 

There  are  many  facts  which  I  could  mention,  in  addition  to  the 
preceding,  which  show  that  the  posterior  columns  of  the  spinal 
cord  afford  passage  to  several  of  the  conductors  of  sensitive  im- 
pressions, but  that,  after  a  short  distance,  they  leave- these  columns 
to  enter  the  gray  matter.  I  refrain  speaking  of  these  facts,  because 
I  think  that  the  above  experiments  are  sufficient.  It  is  useless  to 
try  to  show  that  these  experiments  prove  that  the  idea  that  there 
are  sensitive  fibres  going  to  the  encephalon  in  the  posterior  columns 
must  be  abandoned. 

As  a  general  conclusion,  we  will  say  that  the  conductors  of  sen- 
sitive impressions,  at  their  arrival  in  ther  spinal  cord,  either  enter 
directly  the  central  gray  matter,  or  go  up  or  down  a  little  way  in 
the  posterior  columns,  and  also,  most  likely,  in  the  posterior  gray 
cornua,  and  in  the  posterior  part  of  the  lateral  columns,  and  enter- 
ing afterwards  the  central  gray  matter,  by,  or  in  which,  the  impres- 
sions conveyed  by  these  two  sets  ascend  towards  the  encephalon. 

I  will  add,  that  many  experiments,  some  of  which  are  related  in 
this  lecture,  prove  that  the  restiform  bodies,  which  are  the  con- 
tinuations of  the  posterior  columns,  seem  not  to  give  passage  to 
any  of  the  conductors  of  the  sensitive  impressions  of  either  the 
various  parts  of  the  trunk  and  limbs,  or  of  the  head,  and  that,  there- 
fore, the  cerebellum,  with  which  the  restiform  bodies  are  connected, 
does  not  receive  from  them  any  of  such  conductors. 


28  THE    CENTRAL    NERVOUS    SYSTEM. 

In  another  lecture,  I  will  speak  of  the  singular  hyperesthesia 
which  exists  in  so  high  a  degree  after  the  section  of  the  posterior 
columns  of  the  spinal  cord,  and  also  after  a  deep  section  of  the 
following  parts  on  the  posterior  side  of  the  encephalon :  the  resti- 
form  bodies,  the  cerebellum,  the  anterior  crura  cerebelli,  and  the 
tubercula  quadrigemina. 


29 


LECTURE    III 


PLACE  OF   DECUSSATION   OF   THE  CONDUCTORS   OF   SENSITIVE 
IMPRESSIONS,  IN  THE  CEREBRO-SPINAL  AXIS. 

The  celebrated  experiments  of  Galen,  which  had  been  universally  considered  as 
showing  that  there  is  no  decussation  of  the  conductors  of  sensitive  impres- 
sions, in  the  spinal  cord,  do  not  prove  anything  in  this  respect. — Experiments 
showing  that  the  conductors  of  sensitive  impressions  from  the  various  parts 
of  the  trunk  and  limbs  make  their  decussation  in  the  spinal  cord,  and  not  in 
the  encephalon,  as  was  admitted. 

Mr.  President  and  Gentlemen:  The  question  I  am  about 
treating  has  had  a  singular  fate;  considered  as  solved  for  a  great 
many  centuries,  it  has  hardly  been  the  object  of  the  attention  of 
scientific  men  in  our  days.  Until  1849,  when  I  first  published  the 
discovery  I  had  just  made,  that  there  is  a  decussation  of  the  con- 
ductors of  sensitive  impressions  in  the  spinal  cord,  it  had  been  uni- 
versally admitted  that  Galen  had  proved  that  there  is  no  such 
crossing  in  the  spinal  cord,  and  that,  therefore,  these  conductors 
must  make  their  decussation  in  the  encephalon.  Physiologists  and 
pathologists  agreed  in  attributing  to  Galen  the  merit  of  having 
given  a  demonstration,  in  this  respect,  although  he  seems  never  to 
have  tried  to  solve  the  question.  In  detailing  his  experiments  on 
the  spinal  cord,1  he  does  not  say  a  single  word  concerning  sensibi- 
lity, and  it  is  upon  the  falsely  understood  results  of  these  experi- 
ments, that,  for  a  great  many  centuries,  medical  men  have  based 
their  opinions  that  there  is  no  decussation  of  the  conductors  of 
sensitive  impressions  in  the  spinal  cord. 

Haller2  also  speaks  of  voluntary  movements,  and  not  of  sensi- 
bility in  mentioning  the  effects  of  a  section  of  a  lateral  half  of  the 

1  See  his  following  works  :  "  De  Locis  affectis,"  Lib.  III.  cap.  xiv.,  et  "De  Ana- 
tomicis  administrationibus,"  Lib.  VIII.  sect.  vi. 

2  "  Elementa  Physiologise,"  vol.  iv.  pp.  326  and  334.  In  one  of  these  places  he 
says  just  the  reverse  of  what  he  affirms  in  the  other,  as  regards  voluntary  move- 
ments. 


30  THE    CENTRAL    NERVOUS    SYSTEM. 

spinal  cord.  Lorry,  Fode'ra,  Flourens,  Calmeil,  and  many  other 
physiologists,  have  studied  the  effects  of  an  injury  to  one  half  of 
the  medulla  oblongata,  but  none  of  them  has  directly  examined  if 
there  is  a  decussation  of  the  sensitive  fibres  in  the  spinal  cord ;  and 
in  their  experiments  on  the  medulla  oblongata  they  looked  almost 
only  at  the  effects  on  movements  (paralysis  and  convulsions),  and 
they  hardly  mention  the  state  of  sensibility. 

Sir  Charles  Bell  is  the  first  biologist  who  has  tried  to  determine 
the  real  place  of  decussation  of  the  conductors  of  sensitive  impres- 
sions in  the  cerebro-spinal  axis.  He  imagines  that  it  is  in  a  small 
part  of  the  length  of  the  floor  of  the  fourth  ventricle  above,  and 
near  the  crossing  of  the  pyramids  ;x  but  he  does  not  give  any  rea- 
son in  proof  of  his  idea,  except  the  results  of  a  deceptive  anato- 
mical dissection,  quite  in  opposition  with  the  results  of  the  import- 
ant researches  of  John  Eeid,  of  Solly,  of  Valentin,  and  other  ana- 
tomists. 

Longet  also  has  tried  to  show  the  place  of  decussation  of  the 
conductors  of  sensitive  impressions.2  He  admits  that  the  sensi- 
tive fibres,  after  having  passed  through,  the  cerebellum,  go  towards 
the  tubercula  quadrigemina,  along  the  processus  cerebelli  ad  testes, 
and  that  they  make  their  decussation  below  the  tubercles.  The 
erroneousness  of  this  view  is  pretty  evident  from  the  fact  that  the 
sensitive  fibres  do  not  pass  through  the  cerebellum,  so  that  the 
fibres,  which  really  seem  to  make  a  decussation  where  the  anterior 
peduncles  of  the  cerebellum  coalesce,  below  the  tubercula  quadri- 
gemina, cannot  be  the  continuation  of  the  sensitive  fibres  of  the 
body. 

We  will  try  to  prove  that  the  conductors  of  sensitive  impressions 
make  their  decussation  in  the  neighborhood  of  the  place  of  inser- 
tion of  the  sensitive  nerves,  or  roots  of  nerves,  in  the  cerebro- 
spinal axis.  As  regards  the  sensitive  fibres  of  the  trunk  and  limbs, 
we  will  try  to  show  that  their  decussation  takes  place  in  the  spinal 
cord.  The  following  experiments  seem  to  be  decisive  in  this  re- 
spect : — 

1st.  The  spinal  cord  of  a  mammal  is  laid  bare  at  the  level  of  the 
two  or  three  last  dorsal  vertebrae,  and  a  lateral  half  of  this  organ 
(including  the  posterior,  the  lateral,  and  the  anterior  columns,  and 

1  See  the  "  Nervous  System  of  the  Human  Body,"  3d  edition.  London,  1844,  pp. 
231-40. 

2  "  Anatomie  et  Physiol,  du  Syst.  Nerveux,"  1843,  vol.  i.  pp.  385  and  421. 


DECUSSATION    OF    SENSITIVE    CONDUCTORS.  31 

all  the  gray  matter  on  one  side)  is  divided  transversely.  (See  Fig. 
9,  s.)  The  animal  is  left  at  rest  for  a  little  while,  and  then  it  is 
ascertained  that  sensibility  seems  to  be  much  increased  in  the  pos- 
terior limb  on  the  side  of  the  section,  while  it  seems  to  be  lost,  or 
extremely  diminished,  in  the  posterior  limb  on  the  opposite  side. 
There  seems  to  be,  therefore,  hyperesthesia  behind  and  on  the  side 
of  a  transversal  section  of  a  complete  lateral  half  of  the  spinal  cord; 
while,  on  the  contrary,  there  seems  to  be  anaesthesia  behind  the  sec- 
tion, and  on  the  opposite  side. 

This  experiment  is  one  of  the  two  made  by  Galen ;  but  he  seems 
not  to  have  looked  at  all  at  the  condition  of  sensibility,  and  he 
simply  states  that  there  is  a  paralysis  on  the  side  of  the  section, 
and  no  paralysis  on  the  opposite  side. 

Sir  Astley  Cooper,  under  the  suggestion  of  Dr.  Yelloly,1  has 
made  a  similar  experiment,  except  that  the  section  was  higher ;  the 
state  of  sensibility  is  not  mentioned,  and,  as  regards  movements, 
there  was  paralysis  on  the  side  operated  upon. 

Schceps,  Yan  Deen,  and  Stilling  have  observed  that  sensibility 
is  not  lost  in  the  limb  or  limbs  behind,  and  on  the  side  of  the  sec- 
tion of  a  lateral  half  of  the  spinal  cord ;  but  they  have  not  remarked 
the  most  important  fact,  that  on  the  opposite  side  there  is  ahgesthe- 
sia.  They  also  do  not  mention  this  curious  result  of  this  experi- 
ment, the  existence  of  hyperesthesia  on  the  side  of  the  injury. 

Fodera  was  very  near  discovering  that  there  is  a  decussation 
of  the  sensitive  fibres  in  the  spinal  cord.  He  says  he  has  found 
in  some  cases,  that  a  section  of  one  of  the  posterior  columns  caused 
a  diminution  of  sensibility  in  the  opposite  side  of  the  body ;  but 
he  states  that  in  other  cases  he  has  seen  the  reverse.  He  also  has 
sometimes  remarked  that  the  section  of  one  of  the  posterior 
columns  causes  hyperesthesia  in  the  same  side,  and  that  a  section 
of  these  two  columns  produces  hyperesthesia  in  the  two  sides,  but 
he  declares,  also,  that  he  has  seen  the  reverse.2 

Two  explanations  for  some  of  the  results  of  a  section  of  a  late- 
ral half  of  the  spinal  cord  may  be  proposed,  as  regards  sensibility. 
Either  it  may  be  imagined,  as  it  has  been  by  several  German  phy- 
siologists, that  the  gray  matter  has  the  power  of  transmitting  sen- 
sitive impressions  in  such  a  manner  that  one  lateral  half  of  this 
substance  is  sufficient  for  the  two  sides  of  the  body,  or  that  the 

1  Medico-Chirurgical  Transactions,  vol.  i.  p.  200,  et  seq. 

2  See  his  paper  in  Magendie's  Journal  de  Phvsiologie,  vol.  iii.  p.  191-217. 


32  THE    CENTRAL    NERVOUS    SYSTEM. 

conductors  of  sensitive  impressions  decussate  in  the  spinal  cord,  so 
that  those  which  come  from  the  left  side  of  the  body  pass  into  the 
right  side  of  the  spinal  cord,  and  vice  versa.  The  hypothesis  of  the 
Germans  may  explain  the  fact  that  sensibility  persists  on  the  side 
of  the  section,  but  it  is  proved  to  be  absolutely  inadmissible  by  the 
fact  that  there  is  anaesthesia  on  the  opposite  side.  We  will  see 
that  the  other  experiments  we  have  to  mention  are  also  in  oppo- 
sition to  the  view  of  the  Germans  (Stilling,  Schiff,  and  others). 
On  the  contrary,  all  the  facts  concur  to  prove  the  existence  of  a 
decussation. 
K-  2d.  If,  after  having  made  a  first  section  of  a  lateral  half  of  the 
spinal  cord  in  the  dorsal  region,  on  the  right  side,  for  instance  (see 
Fig.  9,  5),  and  after  having  ascertained  that  the  right  posterior  limb 
is  hyperaesthetic,  or  at  least  extremely  sensitive,  we  divide  the  left 
lateral  half  of  the  spinal  cord  in  the  cervical  region  (Fig.  9,  s'),  we 
find  then  that  the  right  posterior  limb  loses  entirely,  or  almost  en- 
tirely, its  sensibility.  This  experiment  shows  clearly  that  the  sen- 
sitive impressions  coming  from  the  right  posterior  limb,  after  the 
first  section,  passed  across  the  spinal  cord  from  the  right  into  the 
left  side,  along  which  they  were  transmitted  to  the  encephalon. 

3d.  To  obtain  a  very  striking  result  from  the  experiment  which 
consists  in  only  one  section  of  a  lateral  half  of  the  spinal  cord,  it 
is  better  to  make  it  after  the  posterior  columns  have  been  divided. 
We  know  that  after  this  division  there  is  hyperesthesia  in  the  parts 
of  the  body  which  are  behind  the  section ;  if,  after  having  ascer- 
tained this  fact,  the  section  of  a  lateral  half  is  completed  where  the 
posterior  columns  have  been  divided  (see  Fig.  10,  s  $'),  we  find  that 
the  hyperaesthesia  seems  to  increase  on  the  side  of  the  second  ope- 
ration, while,  on  the  opposite  side,  not  only  the  hyperaesthesia,  but 
sensibility  entirely  disappears. 

4th.  There  is  another  mode  of  proving  that  the  conductors  of 
the  sensitive  impressions  decussate  in  the  spinal  cord.  In  several 
points  of  view  this  mode  of  demonstration  is  superior  to  the  pre- 
ceding. It  consists  in  a  longitudinal  section  of  the  spinal  cord,  an 
experiment  already  made  by  Galen,  but  the  results  of  which,  as 
regards  sensibility,  have  been  overlooked  by  him. 

The  spinal  cord  is  laid  bare  in  the  whole  lumbar  region,  and  a 
careful  division  of  the  entire  extent  of  the  part  of  the  organ  giving 
origin  to  the  nerves  of  the  posterior  limbs,  is  made  so  as  to  sepa- 
rate the  two  lateral  halves  of  the  organ,  one  from  the  other.  If 
this  experiment  could  be  executed  perfectly  well,  nothing  would 


DECUSSATION    OF    SENSITIVE    CONDUCTOKS.  33 

be  divided  in  the  cord  except  the  commissures,  which  unite  the 
right  side  with  the  left  side  of  the  cord,  and  all  the  longitudinal 
elements  of  this  nervous  centre  would  be  left  uninjured;  but  it  is 
impossible  not  to  cut  more  or  less  on  either  side.  However,  when 
the  operation  has  succeeded  well — i.  e.,  when  the  two  separated 
halves  have  been  very  little  injured,  a  striking  result  is  obtained. 
The  voluntary  movements  still  exist  in  the  posterior  limbs  (though 
diminished  on  account  of  the  injury  to  the  muscles  of  the  lumbar 
region),  but  sensibility  is  entirely  lost  in  them.  To  those  who  know 
that  injuries  to  the  spinal  cord,  which  cause  a  diminution  of 
sensibility,  always  produce  a  greater  diminution  of  voluntary 
movements,  this  fact  will  not  be  explained  by  the  supposition  that 
some  injury  has,  then,  been  made  to  the  two  halves  of  the  cord, 
and  that  it  is,  in  consequence  of  this  supposed  injury,  that  the  loss 
of  sensibility  is  due.  At  least  it  will,  I  think,  be  easily  admitted 
that  if  the  two  lateral  halves  of  the  cord  had  been  injured  enough 
to  produce  a  complete  and  a  lasting  anaesthesia,  there  would  be  a 
notable  degree  of  paralysis  of  voluntary  movements.  We  repeat 
that  snch  is  not  the  case:  the  animal  has  the  use  of  his  two  limbs ; 
he  moves  about  pretty  freely,  as  Galen  had  already  said.  The  loss 
of  sensibility,  therefore,  must  depend  on  the  section  of  the  commis- 
sures of  the  spinal  cord,  or,  in  other  words,  on  elements  of  this 
organ  which  cross  each  other  in  the  median  line,  or,  rather,  the 
median  plane. 

If  now  we  compare  the  results  of  this  experiment  with  those  of 
a  transversal  section  of  a  lateral  half  of  the  spinal  cord,  we  find 
that  they  agree  perfectly  in  showing  that  the  conductors  of  the  sen- 
sitive impressions  decussate  in  this  organ.  It  is  useless  to  stop  to 
show  that  the  longitudinal  separation  of  the  lumbar  enlargement 
of  the  spinal  cord  would  not  produce  anaesthesia,  if  the  German 
physiologists  were  right  in  admitting  that  the  gray  matter  has  the 
power  of  transmission  in  every  direction.  It  would  be  useless, 
also,  to  insist  upon  the  disagreement  between  the  results  of  a  lon- 
gitudinal section  of  the  spinal  cord,  and  the  views  of  the  physiolo- 
gists who  admit  that  the  posterior  columns  are  composed  of  sensi- 
tive fibres,  coming  from  the  posterior  roots,  and  going  up  to  the 
encephalon.  These  columns  are  left  almost  entire  and  uninjured, 
and,  nevertheless,  sensibility  is  lost. 

5th.  Another  experiment,  which  is  a  combination  of  two  of  the 
preceding,  gives  a  still  better  proof  of  the  decussation  of  the  con- 
ductors of  sensitive  impressions  in  the  spinal  cord.     A  longitudinal 

c 


34  THE    CENTRAL    NERVOUS    SYSTEM. 

section  is  made  on  the  cervico-brachial  enlargement  of  the  spinal 
cord,  so  as  to  separate  it  in  two  lateral  halves.  I  ascertain  theu 
that  sensibility  is  lost  in  the  two  anterior  limbs,  while  it  remains, 
and  even  seems  to  be  increased,  in  the  two  posterior  limbs.  Of 
course,  if  the  loss  of  sensibility  in  the  two  anterior  limbs  depended 
upon  an  injury  to  the  two  sides  of  the  cord,  and  not  upon  a  section 
of  the  decussating  conductors  of  sensitive  impressions,  there  would 
be  a  loss  of  sensibility,  or,  at  least,  a  diminution  of  it  in  the  poste- 
rior limbs.  The  admission  of  a  decussation  explains  the  two  facts: 
loss  of  sensibility  in  one  set  of  limbs,  and  conservation  in  the 
other  set.  (See  Fig.  11.)  If  we  divide  transversely,  in  the  same 
animal,  the  right  lateral  half  of  the  spinal  cord  (see  Fig.  11,  s),  we 
find  then  that  the  posterior  limb  on  the  same  side  becomes  more 
evidently  hyperaesthetic  than  before,  and  that  the  left  posterior 
limb  loses  its  sensibility.  The  transmission  for  this  last  limb  there- 
fore took  place  by  the  right  half  of  the  cord,  while  that  for  the 
right  posterior  limb  continues  to  take  place  by  the  left  half  of  the 
cord. 

I  think  that  the  facts  I  have  mentioned  sufficiently  show  that 
there  is  a  decussation  of  the  conductors  of  sensitive  impressions 
in  the  spinal  cord.  But  several  questions  remain  to  be  solved  con- 
cerning this  decussation.  The  first  one  we  intend  examining  is, 
whether  the  decussation  is  complete  or  not. 

The  fact  that  the  loss  of  sensibility  seems  to  be  absolutely  com- 
plete, after  a  longitudinal  section  of  the  whole  length  of  the  lumbar 
enlargement  of  the  spinal  cord  seems  to  show  that  all  the  conduc- 
tors of  sensitive  impressions  which  reach  the  cord,  coming  from 
the  posterior  limbs,  make  their  decussation  in  this  enlargement. 
But  if  we  admit  that  the  decussation  is  complete,  how  do  we  ex- 
plain that  there  is  an  appearance  of  sensibility,  and  sometimes  a 
well-marked  degree  of  it,  in  a  limb  on  the  opposite  side  to  that  of 
a  section  of  a  lateral  half  of  the  spinal  cord?  In  the  first  place,  I 
must  say  that  very  often  when  we  try  to  divide  transversely  such 
a  part  of  the  cord,  being  afraid  of  cutting  too  much,  we  leave  un- 
divided a  part  of  the  gray  matter  and  of  the  anterior  column,  so 
that  the  persistence  of  sensibility  in  the  opposite  side  of  the  body 
is  very  natural,  and  not  in  opposition  to  our  views.  Yery  likely 
this  is  what  has  occurred  in  many  of  the  experiments  of  Mr.  Chau- 
veau,  who  says  that  sensibility  always  persists  in  such  a  limb.  If 
there  is  no  notable  diminution  of  sensibility  anywhere,  after  an 
attempt  to  divide  the  lateral  half  of  the  cord,  it  is  certain  that  the 


DECUSSATION    OF    SENSITIVE    CONDUCTOKS.  35 

operation  is  not  complete,  and  that  a  part  has  escaped  division.  It 
is  wonderful  how  smalliis  the  quantity  of  gray  matter  which,  being 
left  undivided,  may  transmit  sensitive  impressions! 

But  even  when  the  operation  has  been  perfectly  performed  in 
certain  animals,  and  especially  guinea-pigs,  in  some  cases,  there 
seems  to  be  a  notable  degree  of  sensibility  remaining  in  the  parts 
of  the  body  which  are  behind  the  section,  on  the  opposite  side.  I 
have  ascertained  that  this  appearance  of  sensibility  is  due  to  a  very 
interesting  cause.  I  suppose  that  the  section  has  been  made  on  the 
right  side  of  the  cord,  above  the  origin  of  the  nerves  of  the  infe- 
rior limbs ;  when  the  left  inferior  limb  is  irritated,  the  impression 
is  brought  to  the  spinal  cord  by  the  posterior  roots  (see  Fig.  4,  p), 
and,  by  a  reflex  action,  the  muscles  of  the  right  inferior  limb  have 
a  spasmodic  contraction,  just  as  if  the  anterior  roots  of  their  nerves 
had  been  irritated,  and  in  consequence  there  is  a  pain  produced 
which  is  of  the  same  kind  as  that  which  Magendie  has  attributed 
to  a  recurrent  sensibility  (see  Lect.  I.).  The  proof  that  the  irritation 
travels,  as  we  believe,  is  given  by  the  facts,  that  if  either  the  ante- 
rior or  the  posterior  roots  of  nerves  are  divided  on  the  right  side, 
behind  the  hemisection  of  the  cord,  the  appearances  of  sensibility 
disappear  in  the  left  inferior  limb.  Starting  from  the  left  limb,  the 
irritation  goes  to  the  spinal  cord;  it  is  reflected  to  the  muscles  of 
the  right  inferior  limb,  along  the  motor  nerve-fibres;  it  comes  back 
again  to  the  spinal  cord,  and  then,  following  the  normal  channel  of 
a  sensitive  impression,  it  passes  from  the  right  half  of  the  spinal 
cord  into  the  left  side,  in  which  it  goes  to  the  encephalon.  Al- 
though the  spasmodic  reflex  contraction  in  the  right  inferior  limb 
is  not  very  strong,  it  is  able  to  give  a  painful  sensation,  on  account 
of  the  hyperesthesia  which  exists  in  this  limb.  (See  Fig.  4,  and 
Lect.  I.) 

As  far  as  experiments  go,  it  is  very  difficult  to  decide  whether 
the  decussation  of  the  conductors  of  sensitive  impressions  is  abso- 
lutely complete  or  not,  but  it  seems  to  be  very  nearly,  if  not  abso- 
lutely, complete.  We  shall  see,  by  and  by,  that  pathological  cases 
seem  to  show  that  the  decussation,  in  man,  is  complete. 

What  is  the  place  of  decussation  of  the  various  posterior  roots 
of  a  pair  of  nerves  ?  I  have  said,  in  the  preceding  lecture,  that 
the  fibres  which  enter  the  spinal  cord,  from  the  posterior  roots,  are 
distributed,  in  this  nervous  centre,  in  such  a  way  that  some  are 
going  upwards,  some  downwards,  and  some  transversely.  There 
are,  therefore,  ascending,  descending,  and  transversal  fibres.    Now, 


36  THE    CENTRAL    NERVOUS    SYSTEM. 

all  these  fibres  reach  the  central  gray  matter,  after  a  short  way, 
above  or  below  their  place  of  entrance,  and  almost  at  once  they 
decussate.  A  great  many  experiments  show  that  this  must  be  the 
arrangement  of  the  conductors  of  sensitive  impressions. 

If  we  divide  transversely  a  lateral  half  of  the  spinal  cord  in  two 
places,  so  as  to  have  three  pairs  of  nerves  between  the  two  sections, 
we  find  that  the  middle  pair  has  almost  the  same  degree  of  sensi- 
bility as  if  nothing  had  been  done  to  the  spinal  cord,  while  the  two 
other  pairs  have  a  diminished  sensibility,  the  upper  one  particu- 
larly in  its  upper  roots,  and  the  lower  one  in  its  lower  roots  :  which 
facts  seem  to  show  that  the  ascending  fibres  of  the  upper  pair,  and 
the  descending  fibres  of  the  lower  one,  have  been  divided  before 
they  had  made  their  decussation. 

If  there  is  only  one  pair  of  nerves  between  two  sections,  its  sen- 
sibility is  almost  entirely  lost,  as  then  the  transversal  fibres  are 
almost  alone  uninjured  (most  of  the  ascending  and  descending  being 
divided),  which  fibres  are  employed  for  reflex  action,  and  hardly 
for  the  transmission  of  sensitive  impressions. 

After  having  divided  transversely  a  lateral  half  of  the  spinal  cord 
in  the  dorsal  region,  if  we  divide  longitudinally  this  organ,  so  as 
to  separate  its  two  lateral  halves  one  from  the  other,  and  at  a  right 
angle  with  the  transversal  section  (see  Fig.  12),  we  find  that  sensi- 
bility persists  in  the  segment  partly  separated  from  the  rest  of  the 
cord,  if  it  is  not  more  than  two  inches  long,  in  a  large  mammal, 
whether  the  longitudinal  section  has  been  made  below  or  behind 
the  transversal  one,  as  is  the  case  in  Fig.  12,  or  above  or  before 
this  transversal  division.  If  the  longitudinal  section  is  more  than 
two  inches  long,  it  is  not  sensitive  in  all  its  length.  When  there 
are  three  pairs  of  nerves  attached  to  it,  the  one  nearest  to  the 
transversal  section  (see  Fig.  12,  1),  is  hardly  able  to  give  slight 
sensations;  the  next  (2)  is  a  little  more  sensitive,  but  much  less 
than  in  a  normal  condition;  and  the  third  is  very  sensitive,  though 
not  so  much  as  the  others  on  the  same  side  and  behind  it.  With 
a  segment  attached  to  the  cord  by  its  upper  extremity,  similar  re- 
sults are  obtained,  and  it  seems  certain,  both  from  these  facts  and 
from  many  others  which  it  is  not  necessary  to  mention,  that  the 
decussation  of  the  conductors  of  the  sensitive  impressions  in  the 
spinal  cord,  whether  they  are,  at  first,  descending  or  ascending, 
takes  place  at  a  short  distance  from  the  point  of  insertion  of  the 
posterior  roots. 

Experiments  upon  the  medulla  oblongata,  to  decide  if  the  cross- 


DECUSSATION    OF    SENSITIVE    CONDUCTORS.  37 

ing  of  the  conductors  of  sensitive  impressions,  coming  from  the 
trunk  and  limbs,  has  taken  place  before  they  reach  this  organ  or 
not,  cannot  give  positive  results,  because  the  reflex  movements  are 
so  energetic  after  a  section  of  a  lateral  half  of  this  nervous  centre, 
that  it  is  very  difficult  to  know  the  degree  of  sensibility.  But 
pathological  facts,  observed  in  man,  will  settle  the  question,  as  we 
shall  show  in  another  lecture.  We  have  not,  however,  to  regret 
that  experiments  on  the  medulla  oblongata  are  useless,  as  it  seems 
that  the  question  of  the  decussation  of  the  conductors  of  sensitive 
impressions,  as  far  as  the  trunk  and  limbs  are  concerned,  is  clearly 
solved  by  the  experiments  on  the  spinal  cord,  mentioned  in  this 
lecture. 

There  are  some  animals  in  which  the  decussation  in  the  spinal 
cord  is  not  so  complete  and  so  immediate  as  it  is  in  mammals;  such 
are  reptiles  and  birds.  This  is  one  of  the  causes  of  some  mistakes 
recently  made  by  an  able  experimenter,  Mr.  Chauveau,  of  Lyons. 
He  operated  upon  pigeons,  and  found  that  after  a  section  of  a  late- 
ral half  of  the  spinal  cord,  sensibility  seemed  to  be  much  dimi- 
nished on  the  same  side,  and  not  at  all  on  the  opposite  side.  He 
concluded,  therefore,  that  there  is  no  decussation.  I  have  ascer- 
tained that  the  results  of  the  experiments  vary  with  the  place  of 
the  section.  If  it  be  made  just  above  the  lumbar  enlargement, 
where  Mr.  Chauveau  makes  it,  the  decussation  having  hardly  begun 
below  this  place,  the  results  are  as  he  says ;  but  if  the  section  be 
made  two  inches  higher,  in  the  dorsal  region,  there  is,  as  in  mam- 
mals, though  less  marked,  an  increased  sensibility  in  the  posterior 
limb  on  the  side  of  the  section,  and  a  diminution  of  sensibility  in 
the  opposite  limb.  The  loss  of  sensibility  is  never  complete,  show- 
ing that  the  decussation  is  not  complete.  The  same  results  are 
obtained  in  reptiles. 

As  regards  some  other  objections  addressed  to  my  theories  by 
Mr.  Chauveau,  I  do  not  think  it  worth  while  to  mention  them  here. 
I  have  tried  recently  to  show  how  little  grounded  they  are,1  and 
more  decisive  arguments  than  those  founded  upon  vivisections  will 
be  given  in  my  lectures  on  the  pathological  cases  which  prove  the 
decussation  in  the  spinal  cord,  and  the  power  of  transmission  of 
the  gray  matter. 

In  the  preceding  lecture,  and  in  this  one,  I  have  tried  to  show 

1  See  my  Journal  de  la  Physiologie  de  l'Honime  et  des  Animaux,  Janvier,  1858, 
pp.  176-189. 


38  THE    CENTRAL    NERVOUS    SYSTEM. 

that  the  sensitive  impressions  follow,  in  the  spinal  cord,  quite  a 
determinate  course,  and  I  think  that  the  facts  I  have  mentioned  to 
establish  what  this  course  is,  are  positive  evidences  that  there  are 
fixed  channels,  and  that  some  of  them  cannot  compensate  for  the 
absence  of  others.  It  is,  therefore,  useless  to  show  the  untenable- 
ness  of  the  theory  of  the  Germans  (Schiff  and  Stilling),  that  the 
gray  matter  has  the  power  of  transmission  in  any  direction,  and 
that  any  small  part  of  it  may  act  for  the  whole,  without  any  dimi- 
nution of  intensity. 

It  may  be  thought  that  experiments  on  animals  can  show  only 
what  relates  to  painful  impressions,  and  not  to  impressions  of  touch, 
of  cold,  of  warmth,  &c.  I  will  try  to  show,  in  the  next  lecture, 
that  the  channel  for  impressions  of  touch,  at  least,  seems  to  be  the 
same  as  that  of  painful  impressions,  in  the  spinal  cord. 


39 


LECTURE    IV. 

ON  VARIOUS  QUESTIONS  RELATING  TO  THE  TRANSMISSION  OF  SENSI- 
TIVE IMPRESSIONS  AND  OF  THE  ORDERS  OF  THE  WILL  TO  MUSCLES, 
THROUGH  THE  SPINAL  CORD  AND  THE  MEDULLA  OBLONGATA. 

Most  of  the  elements  which  are  employed  as  conductors  of  the  purely  tactile  im- 
pressions seem  to  pass  by  the  same  parts  of  the  spinal  cord  as  those  which 
transmit  the  impressions  which  give  pain. — The  disposition  of  the  conductors  of 
the  various  sensitive  impressions  in  the  spinal  cord  is  such  that  very  deep  alte- 
rations of  this  organ  may  not  entirely  destroy  sensibility. — The  gray  matter  of 
the  spinal  cord  seems  to  have  an  important  share  in  the  transmission  of  the 
orders  of  the  will  to  muscles. — The  anterior  columns  of  the  spinal  cord  in  the 
upper  part  of  the  cervical  region  have  but  a  slight  participation  in  voluntary 
movements,  and  the  lateral  columns,  with  the  surrounding  gray  matter,  in  that 
part  of  the  cord,  are  almost  the  only  channels  between  the  will  and  muscles. 

Mr.  President  and  Gentlemen  :  I  hope  I  shall  be  able  to  show, 
in  one  of  the  succeeding  lectures,  that  the  various  sensitive  impres- 
sions— of  touch,  of  pain,  of  temperature,  of  muscular  contractions,  etc. 
— are  transmitted  by  conductors  which  are  quite  distinct  from  one 
another,  and  so  much  so  that  the  conductors  of  painful  impres- 
sions, for  instance,  are  not  more  able  to  convey  other  kinds  of  im- 
pressions than  to  transmit  the  orders  of  the  will  to  muscles.  This 
view  appears  to  be  positively  established  by  pathological  cases  ob- 
served in  man.  I  hope  I  shall  now  be  allowed  to  make  use  of  this 
view  as  if  it  were  proved,  and  I  will  examine  if  the  conductors  of 
tactile  impressions  follow  the  same  course  in  the  spinal  cord  as 
those  of  painful  impressions.  I  will,  at  first,  relate  experiments 
which  seem  to  solve  the  following  question:  Do  the  conductors  of 
tactile  impressions  proceed  to  the  encephalon  along  the  posterior  columns, 
or  do  they  pass  into  the  gray  matter  as  the  conductors  of  impressions  of 
pain  ? 

After  having  divided  transversely  the  two  posterior  columns  of 
the  spinal  cord  in  the  dorsal  region,  in  a  dog,  we  cover  its  eyes  and 
wait  until  it  has  lain  down  in  a  state  of  quietness.  When  it  seems 
to  be  perfectly  quiet,  we  find,  if  we  gently  touch  the  skin  of  one  of 


40  THE    CENTRAL    NERVOUS    SYSTEM. 

its  hind  toes,  that  it  lifts  up  its  head  and  tries  to  see  what  is  the 
cause  of  the  irritation.  It  is  certainly  difficult  to  decide  what  kind 
of  sensation  this  dog  has  felt,  but  I  think  I  may  show  that  it  is  a 
tactile  sensation.  Before  discussing  this  point,  however,  I  must  say 
that  it  is  not  in  consequence  of  a  local  reflex  movement,  shaking 
the  whole  body,  that  the  animal  looks  anxiously  around  it.  If  it 
were  so,  the  movement  of  the  head  would  not  take  place  imme- 
diately after  the  irritation  and  at  the  very  same  time  that  the  irri- 
tated leg  is  withdrawn.  Besides,  after  a  complete  transversal  sec- 
tion of  the  spinal  cord,  when  reflex  movements  are  much  stronger 
than  after  a  section  of  the  posterior  columns,  the  head  of  the  animal 
does  not  move  at  the  time  we  touch  the  under  part  of  its  hind  toes. 
Therefore  the  dog,  in  our  experiment,  moves  its  head  because  the 
touching  of  its  toes  has  directly  given  a  sensation.  When  we  think 
that  there  is  a  real  hyperesthesia  in  these  toes,  it  seems  possible 
that  the  simple  touching  of  the  toes  is  painful;  but  the  hyperses- 
thesia,  I  think,  is  not  of  a  sufficient  degree  for  the  production  of 
pain  from  such  a  trifling  cause.  Still  more,  the  touching  of  other 
parts  of  the  skin  of  the  posterior  limbs,  which  are  endowed  with 
the  same  morbid  power  of  causing  pain  as  the  skin  of  the  toes,  is 
not  followed  by  a  movement  of  the  head;  so  that  it  becomes  very 
probable  that  the  effect  following  the  touching  of  the  toes  depends 
upon  the  propagation  of  a  tactile  impression  to  the  encephalon,  the 
skin  of  the  toes  being  endowed  with  more  tactile  sensibilitv  than 
that  of  the  legs.  The  posterior  columns,  therefore,  seem  not  to  be 
the  only  channels  of  the  tactile  impressions. 

Another  experiment  goes  farther,  and  seems  to  prove  positively 
that  the  posterior  columns  do  not  transmit  directly  any  part  of  the 
tactile  impressions  to  the  sensorium.  If  we  divide  transversely,  in 
the  dorsal  region,  the  whole  of  the  spinal  cord,  except  the  posterior 
columns,  the  touching  of  the  sole  of  the  foot  is  not  followed  by 
any  sign  of  feeling,  and  the  head,  if  the  eyes  are  covered,  remains 
quiet.  At  times,  however,  it  happens  that  the  animal  moves  its 
head  and  its  anterior  limbs,  because  it  has  been  shaken  by  the 
strong  reflex  movements  which  are  produced  in  the  paralyzed 
limbs.  In  this  case  reflex  movements  are  always  more  energetic 
than  after  a  complete  section  of  the  cord,  and  very  much  more 
than  after  the  section  of  the  posterior  columns. 

From  the  above  facts  it  seems  to  result  that  the  transmission  of 
tactile  impressions  to  the  encephalon  does  not  take  place  along  the 
posterior  columns.     Other  experiments,  useless  to  be  mentioned, 


CONDUCTION,    ETC.,    OF    TACTILE    IMPRESSIONS.  41 

show  that  the  gray  matter  of  the  spinal  and  probably  also  the 
anterior  columns  are  the  channels  of  conveyance  of  the  tactile  im- 
pressions to  the  encephalon.  We  shall  not  insist  upon  the  demon- 
stration of  these  conclusions  now,  as  we  shall  again  have  to  ex- 
amine their  value  when  we  compare  the  results  of  experiments  with 
the  results  of  pathological  alterations  of  the  spinal  cord  in  man. 
We  will  then  try  to  show  the  disagreement  between  these  results 
and  a  theory  recently  proposed  by  Mr.  Moritz  Schiff,  according  to 
which  the  posterior  columns  of  the  spinal  cord  are  the  channels  for 
tactile  impressions,  and  the  gray  matter  the  conductor  of  painful 
impressions.1 

We  will  now  say  a  few  words  on  the  decussation  of  the  conduc- 
tors of  tactile  impressions.  If  a  lateral  half  of  the  spinal  cord  has 
been  divided  transversely  in  the  dorsal  region,  we  find  that  when 
we  touch  the  sole  of  the  foot  of  the  posterior  limb  on  the  side  ope- 
rated upon,  the  animal  raises  its  head  and  tries  to  look  at  the  place 
irritated  (in  which  attempt  it  cannot  succeed,  as  its  eyes  are  covered). 
On  the  opposite  side  the  touching  of  the  skin  of  the  toes  does  not 
produce  the  least  effect.  It  seems  therefore  that  the  conductors  of  the 
tactile  impressions  decussate  in  the  spinal  cord,  as  well  as  that  of  pain- 
ful impressions,  so  that  the  right  side  of  this  organ  transmits  to  the 
sensorium  the  impressions  which  come  from  the  left  side  of  the 
body,  and  vice  versd.  We  will  add  that  the  experiments  which 
show  that  the  conductors  of  these  two  kinds  of  sensitive  impres- 
sions decussate  in  the  spinal  cord  are  in  opposition  to  the  view  that 
the  posterior  columns  are  the  channels  for  both  these  kinds  or  for 
either  of  them,  as  it  is  well  known  that  these  two  columns  have  no 
communication  one  with  the  other  unless  it  be  through  the  other 
parts  of  the  cord. 

The  question  relative  to  the  place  of  passage  in  the  spinal  cord, 
of  the  impressions  of  temperature,  and  of  some  other  kinds  of  im- 
pressions, cannot  be  solved  positively  by  vivisections.  We  can  say, 
however,  that  after  a  transverse  section  of  the  whole  spinal  cord, 
except  the  posterior  columns,  in  the  dorsal  region,  the  application 
of  ice  or  of  fire  to  the  toes,  seems  not  to  be  felt,  and  that  also 
spasms  may  be  induced  in  the  muscles  of  the  paralyzed  legs  with- 
out causing  a  sensation.  It  seems,  therefore,  that  the  posterior 
columns  are  not  the  channels  of  transmission  of  these  impressions. 

1  Untersuolmngen  zur  Naturlehre  des  Mensclien  und  der  Thiere.  Von  J.  Mole- 
schott.     Vol.  iv.  pp.  84-87.     1858. 


42  THE    CENTRAL    NERVOUS    SYSTEM. 

Some  experiments  also  seem  to  show  that  the  conductors  of  these 
impressions  decussate  in  the  spinal  cord.  But  pathological  facts 
observed  in  man  will  teach  us  much  more  concerning  all  the  sensi- 
tive impressions  which  are  not  purely  painful,  than  experiments 
upon  animals.  In  consequence,  we  shall  postpone  also,  till  we  come 
to  pathological  facts,  what  relates  to  this  question:  Is  it  possible 
to  recognize  the  place  upon  which  an  impression  is  made,  when 
the  posterior  columns  of  the  spinal  cord  are  divided  or  altered  ? 
We  will  merely  say,  at  present,  that  animals,  after  a  section  of  the 
posterior  columns  or  of  a  lateral  half  of  the  spinal  cord,  seem  to 
discover  the  point  irritated,  as,  although  their  eyes  are  covered, 
they  try  to  bite  near  the  place  upon  which  a  painful  irritation  has 
been  produced. 

I  pass  now  to  another  and  capital  question,  the  solution  of  which 
will  explain  a  great  many  mysterious  pathological  cases  observed 
in  man:  How  is  it  that  sensibility  is  not  lost  and  is  only  more  or 
less  diminished,  although  the  spinal  cord  is  deeply  altered?  This 
question  seems  to  be  solved  by  the  following  experiments :  If  we 
divide  transversely  the  posterior  columns  in  the  upper  part  of  the 
lumbar  region  in  a  mammal,  we  find  that  there  is  hyperesthesia 
everywhere  behind  the  section ;  if,  then,  we  divide  the  posterior  parts 
of  the  lateral  columns  and  the  posterior  gray  horns,  we  find  that 
the  hyperesthesia  increases  also  everywhere  behind  the  section.  If 
the  section  is  carried  farther,  so  that  the  whole  posterior  half  be 
divided  transversely,  the  posterior  part  of  the  gray  matter,  behind 
the  central  canal,  being  cut,  the  hyperesthesia  remains  excessive 
everywhere  behind  the  section.  When  another  section  is  made, 
cutting  a  little  more  of  the  central  gray  matter,  the  hyperesthesia 
disappears  from  everywhere  at  once,  and  a  certain  degree  of  anes- 
thesia appears  also  everywhere  behind  the  section.  At  last,  if  the 
whole  of  the  central  gray  matter  be  divided,  with  also  a  good  part 
of  the  basis  of  the  anterior  horns,  sensibility  is  very  much  diminished 
everywhere  behind  the  division,  and  it  disappears  entirely  everywhere 
at  the  same  time  when  the  section  has  left  only  the  anterior  parts 
of  the  anterior  columns.1     The  general  result  of  this  experiment  is, 

1  I  must  say  that  it  is  absolutely  impossible  to  know,  while  we  make  a  section 
of  parts  of  the  spinal  cord,  what  is  the  precise  depth  of  the  injury ;  it  is  mere  guess- 
work. But  if  we  study  well  the  phenomena,  and  then,  after  having  killed  the 
animal,  if  we  put  the  spinal  cord  in  alcohol,  we  render  it  hard,  and  we  can  ascer- 
tain exactly  what  is  the  extent  of  the  incision.     This  is  the  means  that  I  always 


ARRANGEMENT    OF    SENSITIVE    CONDUCTORS.  48 

that  any  change  that  takes  place  in  the  state  of  sensibility — either 
an  increase  or  a  diminution — shows  itself  everywhere,  at  the  same 
time,  behind  the  section. 

If  we  now  examine  what  might  be  the  disposition  of  the  con- 
ductors of  sensitive  impressions,  in  the  spinal  cord,  we  find  that 
either  they  might  be  scattered  without  any  order  at  all,  or  they 
might  have  one  or  the  other  of  these  two  kinds  of  arrangements: 
1st.  They  might  be  disposed  in  such  a  manner  that  the  anterior 
parts  of  the  body,  the  middle  parts  and  the  posterior  parts,  would 
each  have  a  peculiar  place  in  the  cord.  2d.  They  might  be  arranged 
so  that  each  small  portion  of  the  conducting  part  of  the  cord  would 
contain  conducting  elements  from  the  anterior,  the  middle,  and  the 
posterior  parts  of  the  body.  Now,  if  we  take  the  results  of  the 
above  experiments,  we  find  that  they  agree  with  this  last  supposi- 
tion, and  not  with  the  others.  If  there  was  no  order  in  the  dispo- 
sition of  the  elements  conducting  sensitive  impressions,  in  the  spinal 
cord,  we  should  not  have  found  changes  taking  place  exactly  in  the 
same  measure  in  all  the  parts  of  the  body  behind  the  section — i.  e., 
in  the  skin,  in  the  trunks  of  nerves,  in  muscles,  and  in  the  viscera 
of  the  abdomen.  If  the  anterior  parts  of  the  body  had  their  con- 
ductors of  sensitive  impressions  crowded  together,  as  well  as  the 
posterior  and  middle  parts  also,  we  should  have  found  that  certain 
sections  produced  anaesthesia  in  certain  parts,  and  not  in  others, 
while  on  the  contrary  we  find  anaesthesia,  when  it  first  appears,  be- 
ginning everywhere  at  the  same  time,  and  when  it  increases,  and 
also  when  it  becomes  complete,  we  find  that  it  is  so  everywhere. 
We  must,  therefore,  admit  that  elements  representing  the  various 
parts  of  the  body  exist  in  the  various  portions  of  the  spinal  cord 
from  behind  forwards  in  the  conducting  zone  of  this  organ.  This 
explains  clearly  why  a  complete  loss  of  sensibility  is  so  rare  in  dis- 
eases of  the  spinal  cord. 

What  we  have  said  of  the  various  parts  of  the  body  considered 
from  the  posterior  to  the  anterior  surface,  we  can  say  also  of  the 
various  parts  of  the  body  considered  transversely.  We  have  shown 
that  the  left  side  of  the  spinal  cord  is  the  conductor  of  sensitive 
impressions  coming  from  the  right  side  of  the  body,  and  vice  versa. 
Let  us  now  examine  what  takes  place  in  the  right  posterior  limb 

employ  in  my  experiments,  and  it  is  also  the  means  employed  by  the  Committee 
appointed  by  the  Societe  de  Biologie,  in  1855,  for  the  investigation  of  my  researches 
on  the  spinal  cord. 


44:  THE    CENTRAL    NERVOUS    SYSTEM. 

when  we  divide  the  left  side  of  the  spinal  cord.  We  find  that,  after 
a  division  of  a  part  of  the  left  lateral  column,  there  is  no  diminu- 
tion of  sensibility  anywhere  in  the  right  limb;  if  the  section  is 
deeper,  and  involves  a  part  of  the  gray  matter,  with  the  whole  of 
the  left  lateral  column,  sensibility  is  diminished  everywhere  in  the 
right  posterior  limb;  if  the  section  is  still  deeper,  so  that  there  re- 
mains only  a  very  slight  part  of  the  central  gray  matter,  or  of  the 
anterior  column  on  the  left  side,  sensibility  is  then  much  more 
diminished  everywhere  in  the  right  posterior  limb,  and,  as  in  the 
preceding  case,  the  same  degree  of  diminution  exists  in  all  the  parts 
of  this  limb.  At  last,  when  the  whole  of  the  left  side  of  the  cord 
has  been  divided,  there  is  only  in  the  right  limb  the  false  appear- 
ance of  sensibility  which  has  been  explained  in  the  preceding  lec- 
ture. It  results  from  these  facts,  that  the  various  parts  of  this  limb, 
the  outside  parts,  the  inside  parts,  and  the  middle  parts,  are  not 
represented  in  the  left  side  of  the  spinal  cord  by  conductors  of  sen- 
sitive impressions  disposed  in  distinct  layers;  because,  had  it  been 
so,  the  diminution  of  sensibility,  instead  of  being  gradual  every- 
where, and  appearing  in  all  the  parts  at  the  same  degree,  would 
have  taken  place  in  one  part  more  than  in  another,  after  some  of 
the  sections.  It  seems,  therefore,  that  transversely,  as  well  as  in 
the  direction  from  behind  forwards,  the  spinal  cord,  in  the  various 
parts  of  the  conducting  zone,  contains  fibres  or  other  elements, 
conductors  of  sensitive  impressions  coming  from  the  various  parts 
of  the  body,  one  lateral  half  of  the  cord,  however,  being  the  agent 
of  transmission  for  the  opposite  lateral  half  of  the  body. 

If,  for  instance,  we  imagine  that  there  are  a  thousand  conducting 
elements  coming  from  a  small  part  of  the  right  side  of  the  body, 
in  the  left  half  of  the  spinal  cord,  they  are  scattered  in  all  the  parts 
of  the  conducting  zone  of  this  half,  so  that  to  divide  them  all,  a 
section  must  divide  the  whole  of  this  zone.  In  other  words,  we 
can  sajr,  that  every  small  portion  of  the  conducting  zone  in  a  lateral  half 
of  the  spinal  cord  contains  conductors  of  sensitive  impressions  coming  from 
all  the  points  of  the  body  on  the  opposite  side,  which  are  behind  the  place 
of  this  small  portion.  We  can  say,  also,  that  the  sensitive  impressions 
made  on  any  point  of  a  lateral  half  of  the  body  are  transmitted  to  the 
sensorium  by  conducting  elements,  distributed  in  all  the  parts  of  the 
lateral  half  of  the  spinal  cordon  the  opposite  side. 

This  view,  which  explains  the  so  frequent  persistence  of  sensi- 
bility in  cases  of  disease  of  the  spinal  cord,  is  entirely  different  from 
that  of  Stilling  and  others  who  admit  that  a  part  of  gray  matter  in 


TEANSMISSION    OF    THE    OKDEES    OF    THE   WILL.  45 

one  half  of  the  cord  is  sufficient  for  the  transmission  of  sensitive 
impressions  from  both  sides  of  the  body. 

We  pass  now  to  the  transmission  of  the  orders  of  the  will  to 
muscles  through  the  spinal  cord.  It  is  by  far  very  much  more 
difficult  to  determine  what  are  the  parts  of  this  organ  employed  in 
voluntary  movements  than  to  find  out  what  are  those  through  which 
the  sensitive  impressions  are  transmitted.  I  have  long  been  in 
doubt  in  this  respect,  and  even  now,  after  having  carefully  watched 
a  great  many  animals,  on  the  spinal  cord  of  which  certain  altera- 
tions had  been  made,  and  after  having  read  a  great  many  patholo- 
gical cases,  I  still  hesitate  as  regards  various  points.  I  will  try  in 
this  lecture  to  show  what  seems  to  be  positive,  and  I  will  also  point 
out  some  of  the  questions  that  seem  not  to  have  yet  been  solved. 

It  is  very  well  known  that  Sir  Charles  Bell  did  not  give  any 
proof  of  the  idea  that  he  seems  to  have  entertained  all  his  life,  that 
the  anterior  columns  of  the  spinal  cord  are  the  only  channels  by 
which  the  will  exercises  its  power  on  muscles.  Most  of  the  physio- 
logists who  have  experimented  on  this  subject  admit  that  a  trans- 
versal section  of  the  anterior  columns  is  a  cause  of  paralysis. 
Stilling  alone  does  not  admit  the  exactitude  of  this  assertion. 
Various  experiments  which  I  will  relate  show  how  difficult  it  is  to 
decide  most  of  the  questions  on  this  subject. 

If  we  divide  transversely,  in  the  dorsal  region,  the  two  posterior 
columns  of  the  spinal  cord  in  a  mammal,  we  find  that  its  voluntary 
movements  seem  not  to  be  at  all  disturbed  or  diminished.  If  in 
another  mammal  we  divide  transversely  the  whole  of  the  spinal 
cord,  except  the  posterior  columns,  we  do  not  find  the  least  appear- 
ance of  a  voluntary  movement  in  the  muscles  which  receive  their 
nerves  from  the  parts  of  the  spinal  cord  which  are  behind  the  sec- 
tion. So  far,  therefore,  as  the  posterior  columns  alone  are  con- 
cerned, we  arrive  at  a  positive,  and,  I  think,  undeniable  conclusion, 
which  is,  that  the  posterior  columns  of  the  spinal  cord  are  not  directly 
employed  in  the  conveyance,  of  the  orders  of  the  will  to  muscles. 

If  we  compare  this  conclusion  with  this  well-known  fact,  that 
there  are  several,  I  may  even  say  many,  pathological  cases,  showing 
that  in  man  an  alteration  of  the  posterior  columns  has  caused 
nothing  but  a  loss  or  a  diminution  of  voluntary  and  reflex  move- 
ments, we  find  an  appearance  of  contradiction  which  in  reality,  how- 
ever, does  not  exist,  as  I  will  show  in  another  lecture. 

After  having  divided  transversely  the  two  posterior  columns  as 
in  the  preceding  experiment,  if  we  divide  a  part  of  the  lateral 


46  THE    CENTRAL    NERVOUS    SYSTEM. 

columns  and  the  posterior  gray  horns  (see  1,  Fig.  13),  we  find  that 
there  is  an  evident,  although  very  slight  diminution  of  voluntary 
movements.  But  now,  if  instead  of  dividing  this  part  of  the  spinal 
cord,  we  divide  the  whole  of  this  organ,  except  this  part,  we  find 
that  voluntary  movements  are  completely  lost.  It  seems,  there- 
fore, that  there  are  some  conductors  for  voluntary  movements  in 
either  the  posterior  horns  or  the  posterior  part  of  the  lateral  columns, 
or  in  both ;  but  it  appears  also  that  there  is  but  a  small  number  of 
such  conductors  in  either  of  these  parts. 

If  we  divide  transversely,  in  the  dorsal  region,  the  whole  pos- 
terior half  of  the  gray  matter,  and  a  part  of  the  lateral  columns, 
besides  the  posterior  columns  (see  2,  Fig.  13),  we  find  that  the 
voluntary  movements  are  much  diminished  in  the  abdominal  limbs. 
If  the  division  is  carried  farther,  so  that  the  whole  of  the  central 
gray  matter  be  divided  (see  3,  Fig.  13),  the  animal  can  hardly 
move  its  abdominal  limbs;  and  if  we  add  to  this  section  that  of  the 
anterior  horns  of  gray  matter,  the  loss  of  voluntary  movements 
seems  to  be  complete. 

These  experiments  seem  to  lead  to  the  conclusion  that  the  ante- 
rior columns  of  the  spinal  cord  are  not  at  all  employed  in  voluntary 
movements;  but  now,  on  the  other  side,  if  we  divide  only  the  ante- 
rior columns  in  the  dorsal  region,  we  find  voluntary  movements 
almost  entirely  lost,  in  the  abdominal  limbs — a  fact  which  seems  to 
prove  that  the  anterior  columns  are  the  principal  channels  for  the 
orders  of  the  will  to  muscles.  Besides,  if  we  compare  the  results 
of  the  two  experiments  represented  in  Fig.  13,  at  3  and  4,  we  find 
in  the  case  of  a  section  of  little  more  than  the  posterior  half  of  the 
spinal  cord,  that  voluntary  movements  are  almost  entirely  lost : 
while,  in  the  case  of  a  section  of  less  than  the  anterior  half  (see  4, 
Fig.  13),  voluntary  movements  seem  to  be  entirely  lost.  We  do 
not  see  any  other  way  of  explaining  these  various  results  except  in 
admitting,  what  seems  to  be  proved  by  thousands  of  pathological 
cases  and  vivisections,  that  voluntary  movements  require  very 
powerful  excitations  from  the  nervous  system  upon  muscles,  and 
that  when  one-half  or  one-third  of  the  normal  amount  of  excitation 
is  missing,  what  remains  is  insufficient. 

If  we  add  to  the  preceding  experiments  that  any  injury  to  the 
central  gray  matter,  and  that  a  deep  injury  to  the  lateral  columns. 
in  the  dorsal  region,  always  produce  a  diminution  of  the  voluntary 
movements,  we  are  led,  by  all  the  facts  we  have  mentioned,  to  the 
conclusion  that,  in  the  dorsal  tegion,  the  various  ^ar/s  of  the  spinal 


DECUSSATION    OF    VOLUNTARY    MOTOR    CONDUCTORS.       47 

cord,  except  the  posterior  columns,  seem  to  be  employed  in  the  conveyance 
of  the  orders  of  the  will  to  muscles. 

Now,  as  regards  the  question,  which  of  these  parts  of  the  spinal 
cord  is  the  principal  channel  for  the  orders  of  the  will  ?  we  cannot 
give  a  very  positive  opinion.  We  can,  however,  state  that  of  these 
three  parts — the  lateral  columns,  the  anterior  columns,  and  the  gray 
matter — each  of  the  last  two  seems  to  have  a  greater  share  in  this 
function  than  the  first.  Besides,  the  gray  matter  appears  to  have 
as  great  a  share  as  the  anterior  columns,  and  in  the  gray  matter 
the  most  important  parts  seem  to  be  those  in  the  anterior  half  of 
the  cord. 

In  the  upper  part  of  the  cervical  region  of  the  spinal  cord,  near 
the  crossing  of  the  anterior  pyramids,  the  results  of  experiments  on 
the  various  parts  of  the  spinal  cord  are  very  different  from  those 
of  the  same  experiments  in  the  dorsal  region.  In  that  part  of  the 
cervical  region  it  is  the  section  of  the  lateral  columns,  and  of  the 
part  of  the  gray  matter  placed  between  the  anterior  and  the  lateral 
columns,  which  produces  the  most  decided  effect  on  voluntary 
movements — viz.,  a  complete  paralysis.  The  section  of  the  anterior 
columns  alone,  when  it  has  been  made  without  a  notable  injury  of 
the  neighboring  parts,  causes  a  diminution  of  voluntary  move- 
ments, which  is  by  far  not  so  considerable  as  after  a  section  of 
these  columns  in  the  dorsal  region.  The  section  of  the  posterior 
columns  and  of  the  posterior  parts  of  the  gray  matter  in  the  cervi- 
cal region  hardly  causes  a  diminution  in  the  energy  of  the  volun- 
tary movements.  From  these  results  we  conclude  that  in  the  upper 
part  of  the  cervical  region  of  the  spinal  cord,  near  the  medulla  oblongata, 
most  of  the  conductors  of  the  orders  of  the  will  to  muscles  are  in  the 
lateral  columns  and  in  the  gray  matter  between  these  and  the  anterior 
columns. 

Is  there  any  decussation  of  the  voluntary  motor  conductors  in 
the  spinal  cord?  The  celebrated  experiments  of  Galen,  which  we 
have  already  mentioned,  seem  to  answer  positively  that  there  is  no 
such  decussation.  Haller  (Elem.  Phys.,  vol.  iv.  p.  326)  says:  "Alte- 
rius  demum  lateris  musculi  resolvuntur,  si  climidiam  medullam 
spinalem  dissecueris."  It  is  probable  that  his  assertion  in  this  case 
was  not  grounded  upon  any  experiment  made  by  himself.  He 
quotes  as  his  authority  Galen,  who  had  said  the  reverse,  and  Oribase, 
who  seems  to  have  copied  Galen.  In  the  same  volume  of  his  great 
work  {loco  cit.,  p.  '334),  Haller  gives  the  very  opposite  assertion. 
He  says:  "Id  latus  corporis  resolvitur  in  quo  ea  medulla  vulnus 


48  THE    CENTRAL    NERVOUS    SYSTEM. 

passa  est  aut  pressionem."  In  the  experiment  already  quoted,  which 
was  made  by  Sir  Astley  Cooper  on  the  cervical  part  of  the  spinal 
cord  of  a  dog,  the  section  of  a  lateral  half  of  this  organ  produced  a 
loss  of  voluntary  movements  in  the  corresponding  side  of  the  body. 
Most  of  the  living  experimenters  agree  upon  this  fact  that  such  a 
section  causes  paralysis  only  on  the  side  injured.  I  have  ascer- 
tained, a  great  many  times,  that  this  is  not  entirely  right.  There 
is  always,  even  in  mammals,  after  a  transversal  section  of  the  whole 
of  a  lateral  half  of  the  spinal  cord,  at  least  some  appearance  of 
voluntary  movements  in  the  side  of  the  injury,  and  always  also  a 
diminution  of  voluntary  movements  in  the  opposite  side ;  so  that, 
in  animals,  there  seems  to  be  in  the  spinal  cord  a  decussation  of  a 
few  of  the  voluntary  motor  conductors.  As  there  seems  to  be  no 
such  decussation  in  man,  at  least  according  to  several  pathological 
facts,  we  shall  not  insist  on  its  existence  in  animals. 

We  have  now  to  say  a  few  words  on  a  theory  which  was  first 
proposed  by  Bellingeri,1  and  had  the  good  fortune  of  being  accepted 
by  an  eminent  physiologist,  Professor  Valentin,  of  Bern.2  Accord- 
ing to  these  experiments,  the  motor  nerve-fibres  which  go  to  the 
extensor  muscles  pass  in  the  posterior  columns,  while  those  which 
go  to  the  flexor  muscles  pass  in  the  anterior  columns.  AYe  have 
already  said  that  a  section  of  the  posterior  columns  does  not  pro- 
duce any  kind  of  paralysis,  so  that  they  are  not  more  for  extension 
than  for  flexion.  But  the  question  remains  whether  the  other  pos- 
terior parts  of  the  spinal  cord  are,  or  are  not  employed  for  one  of 
these  kinds  of  movements  more  than  for  the  other.  To  solve  this 
question,  we  divide,  in  the  dorsal  region,  the  posterior  half  of  the 
spinal  cord  (see  2  and  3,  Fig.  13)  in  a  mammal,  and  nearly  the 
whole  of  the  anterior  half  of  this  organ  in  another  (see  4,  Fig.  13); 
and  we  find  that  all  the  muscles  seem  to  be  almost  completely 
paralyzed  in  the  abdominal  limbs,  the  flexors  as  much  as  the  ex- 
tensors, in  the  two  animals.  If  some  pathological  facts  observed  in 
man,  and  of  which  we  will  speak  in  another  lecture,  appear  to  be 
different  from  these  facts,  we  will  show  that  there  was  in  them  an 
irritation,  and  not  a  destruction  or  a  section,  of  certain  parts  of  the 
spinal  cord  or  of  its  nerves. 

As  regards  the  place  of  passage  of  the  voluntary  motor  conduc- 
tors in  the  medulla  oblongata,  I  will  now  say  only  a  few  words. 

1  De  Medulla  Spinali  Nervisque  ex  ea  Prodeuntibus,  &c.     Torino,  1823. 

2  De  Functionibus  Nervorum  Cerebralium,  &c.     1839. 


DECUSSATION    OF    MOTOR    CONDUCTORS.  49 

The  crossing  of  the  anterior  pyramids  I  shall  try  to  prove  by  and 
by  to  be  very  nearly  the  only  one  for  the  conductors  for  voluntary 
movements.  I  will  merely  state  now  that  if  a  section  is  made 
longitudinally  just  at  the  place  of  the  decussation  of  the  anterior 
pyramids,  so  as  to  divide  entirely  all  the  decussating  elements,  we 
find  that,  although  the  animal  lives  some  time  after  the  operation, 
it  has  no  voluntary  movement  at  all  in  any  of  its  limbs,  which  are 
almost  always  the  seat  of  convulsions.  A  section  of  the  two  ante- 
rior pyramids  is  followed  by  the  same  results,  while  a  section  of  the 
olivary  columns,  which  are  chiefly  the  continuation  of  the  anterior 
columns  of  the  spinal  cord,  does  not  seem  to  produce  a  notable 
paralysis ;  so  that  the  greatest  difference  exists  between  the  spinal 
cord  and  the  medulla  oblongata,  as  to  the  place  of  passage  of  the 
voluntary  motor  conductors. 

From  the  facts  we  have  related,  concerning  voluntary  movements, 
we  think  it  may  be  concluded  that  the  idea  that  there  are  two 
columns  of  the  spinal  cord  (the  anterior)  alone  employed  in  the. 
production  of  these  movements,  must  be  completely  abandoned. 
It  is  extremely  probable  that  the  voluntary  motor  conductors  pass 
in  the  anterior  pyramids,  and,  after  having  made  their  decussation, 
pass  chiefly  in  the  lateral  columns  of  the  spinal  cord  and  in  the 
gray  matter  near  these  columns,  and,  at  last,  that,  after  a  short  dis- 
tance, a  number  of  these  conductors  leave  the  lateral  columns  to 
pass  into  the  gray  matter  and  into  the  anterior  columns. 

As  regards  the  practical  deductions  from  the  various  facts  we 
have  related,  concerning  the  channels  of  sensitive  impressions,  and 
of  the  orders  of  the  will  to  muscles,  they  will  be  discussed  in  the 
future  lectures. 


50 


LECTURE    Y. 

CONCLUSIONS  FROM  THE  FACTS  MENTIONED  IN  THE  PRECEDING  LEC- 
TURES, AND  PATHOLOGICAL  CASES  SHOWING  THAT  THE  TRANSMIS- 
SION OF  SENSITIVE  IMPRESSIONS  SEEMS  NOT  TO  TAKE  PLACE  THROUGH 
THE  POSTERIOR  COLUMNS  OF  THE  SPINAL  CORD. 

Conclusions  from  the  results  of  the  Lecturer's  experiments  concerning  the  trans- 
mission of  sensitive  impressions  and  of  the  orders  of  the  will  to  muscles,  in  the 
cerebro-spinal  axis. — Agreement  between  the  three  principal  sources  of  our 
knowledge  concerning  the  spinal  cord  considered  as  a  conductor  of  sensitive 
impressions  and  voluntary  movements :  i.e.,  anatomy,  experimentation  upon 
animals,  and  pathological  cases  observed  in  man. — Hyperesthesia  or  conserva- 
tion of  sensibility  after  injury  to  the  posterior  columns. 

Mr.  President  and  Gentlemen  :  In  the  preceding  lectures  I 
have  related  a  great  many  experiments  which  have  given  results, 
or  which  may  lead  to  conclusions,  some  of  which  I  have  already 
mentioned,  while  there  are  others  of  which  I  have  hardly  spoken. 
It  will  be  useful  now  to  give,  together,  most  of  these  conclusions 
or  results,  before  I  relate  the  pathological  cases  which  seem  to  con- 
cur with  ray  experiments  in  proving  the  exactitude  of  these  facts 
or  deductions.  I  will  mention  most  of  them  without  discussion, 
and  say  only  a  few  words  in  the  way  of  explanation  about  two  or 
three  of  them. 

1st.  The  laying  bare  of  the  spinal  cord,  and  its  free  exposure 
to  the  action  of  the  atmosphere,  instead  of  being  a  cause  of  loss  or 
diminution  of  sensibility,  as  has  been  said,  seems  to  be  followed  by 
a  marked  increase  of  sensibility  in  the  parts  of  the  body  which  are 
behind  the  point  where  the  cord  is  exposed. 

2d.  The  laying  bare  of  the  spinal  cord,  even  in  mammals,  is  very 
rarely  followed,  even  after  a  number  of  days,  by  any  kind  of  accident 
(meningitis,  myelitis,  &c.)  producing  a  diminution  of  sensibility. 

3d.  The  posterior  columns  of  the  spinal  cord  are  not,  as  has  been 
imagined,  a  bundle  of  fibres,  from  the  posterior  roots  of  the  spinal 
nerves,  going  up  to  the  encephalon. 


CONCLUSIONS    IN    REGARD    TO    THE    SPINAL    CORD.        51 

4th.  The  restiform  bodies  are  not  a  collection  of  fibres,  chiefly 
from  the  sensitive  nerves  of  the  various  parts  of  the  body,  going  up 
to  the  encephalon,  and,  therefore,  the  cerebellum  is  not  the  recipient, 
through  the  restiform  bodies,  of  most  of  the  sensitive  fibres  of  the 
trunk  and  limbs. 

5th.  The  hyperesthesia  which  appears  in  all  parts  of  the  body, 
behind  deep  injuries  to  the  posterior  columns  of  the  spinal  cord, 
is  always  more  marked  than  that  which  is  due  to  the  mere  laying 
bare  of  this  nervous  centre. 

6th.  All  parts  of  the  encephalon  which  are  situated  in  its  pos- 
terior or  superior  side  are  like  the  posterior  columns  of  the  spinal 
cord,  in  this  respect — that  a  marked  degree  of  hyperesthesia  always 
follows  a  transverse  section  upon  any  of  them. 

(If  a  complete  transverse  section  is  made  upon  any  part  of  the 
restiform  bodies,  sensibility  becomes  very  much  increased  in  every 
part  of  the  trunk  and  limbs.  Hyperesthesia  is  also,  but  in  a  less 
degree,  one  of  the  results  of  a  transversal  incision  in  the  cerebellum, 
in  the  processus  cerebelli  ad  testes,  and  in  the  tubercula  quadrige- 
mina.) 

7th.  A  section  of  either  the  anterior  or  the  lateral  columns  is 
followed  by  a  certain  degree  of  hyperesthesia. 

8th.  The  hyperesthesia  is  greater  after  a  section  of  the  posterior 
columns  and  the  posterior  horns  of  gray  matter  and  the  neighbor- 
ing parts  of  the  lateral  columns  and  central  gray  matter,  than  after 
a  section  of  any  other  part  of  the  spinal  cord. 

9th.  The  power  of  transmission  of  a  nervous  excitation,  for  either 
sensation  or  movement,  may  exist  in  parts  of  the  nervous  system 
which  are  not  excitable. 

10th.  The  posterior  columns  of  the  spinal  cord  are  much  less 
sensitive  than  they  are  said  to  be,  and  it  even  seems  that  their 
apparent  sensibility  depends  upon  the  fact,  that  when  they  are 
irritated,  the  posterior  roots,  which  are  very  sensitive,  are  also  more 
or  less  irritated. 

11th.  The  restiform  bodies  seem  to  be  deprived  of  sensibility  to 
mechanical  excitation. 

12th.  Of  the  fibres  sent  to  the  spinal  cord  by  the  posterior  roots, 
some  go  transversely,  which  do  not  seem  to  be  employed  for  the 
transmission  of  sensitive  impressions.  Others  go  upwards  and 
others  downwards,  both  of  which  are  conductors  of  sensitive  im- 
pressions. These  two  sets  of  conductors,  the  ascending  and  the 
descending,  seem  to  go  ultimately  into  the  central  gray  matter  of 


52  THE    CENTRAL    NERVOUS    SYSTEM. 

the  cord  or  into  the  anterior  columns,  after  having,  for  a  short  dis- 
tance, passed  through  the  posterior  columns,  and  most  likely  also 
through  the  lateral  columns  and  the  posterior  gray  horns. 

13th.  The  transmission  of  sensitive  impressions  to  the  encephalon 
takes  place  chiefly  in  the  central  gray  matter  of  the  spinal  cord, 
and  for  a  small  part  in  the  anterior  columns. 

14th.  The  decussation  of  the  conductors  of  sensitive  impressions, 
coming  from  the  various  parts  of  the  trunk  and  limbs,  does  not 
take  place  in  the  upper  part  of  the  pons  Varolii  nor  beneath  the 
tubercula  quadrigemina,  nor  in  the  medulla  oblongata,  as  it  has  been 
imagined.  It  takes  place  in  the  spinal  cord  in  the  case  of  sensitive 
impressions  conveyed  by  the  posterior  roots  of  the  spinal  nerves. 

15th.  The  decussation  of  the  conductors  of  sensitive  impressions 
in  the  spinal  cord  takes  place  very  near  their  place  of  entrance  into 
this  organ,  some  above  and  others  below  this  place. 

16th.  The  transmission  of  sensitive  impressions  through  the  spinal 
cord  takes  place  in  certain  definite  directions,  and  not,  as  several 
German  physiologists  have  thought,  in  almost  every  direction. 

17th.  Every  small  portion  of  a  transverse  section  of  the  conduct- 
ing zone,  in  a  lateral  half  of  the  spinal  cord,  contains  conductors  of 
sensitive  impressions  coming  from  all  the  points  of  the  body,  on 
the  opposite  side,  which  are  behind  the  place  of  this  small  portion. 

18th.  The  sensitive  impressions  made  on  any  point  of  a  lateral 
half  of  the  body  are  transmitted  to  the  sensorium  by  conducting 
elements,  distributed  in  all  the  parts  of  the  lateral  half  of  the 
spinal  cord  on  the  opposite  side. 

(This  conclusion  and  the  preceding  explain  why  the  transmission 
of  sensitive  impressions  is  so  rarely  lost  in  pathological  alterations 
of  the  spinal  cord,  and  also  why  the  degree  of  diminution  of  sensi- 
bility in  those  cases  is  nearly  in  the  same  degree  in  almost  all  the 
parts  where  it  exists.) 

19th.  Most  of  the  elements  which  are  emplo}7ed  as  conductors  of 
the  purely  tactile  impressions,  seem  to  pass  by  the  same  parts  of 
the  spinal  cord  as  those  which  transmit  the  impressions  which  pro- 
duce pain. 

20th.  The  posterior  columns  of  the  spinal  cord  are  not  directly 
employed  in  the  conveyance  of  the  orders  of  the  will  to  muscles. 

21st.  The  gray  matter  of  the  spinal  cord  seems  to  have  an  im- 
portant share  in  the  conveyance  of  the  orders  of  the  will  to  muscles. 

22d.  The  lateral  columns  of  the  spinal  cord  have  a  notably 
greater  share  in  the  conveyance  of  the  orders  of  the  will  to  muscles 


CONCLUSIONS    IN    REGARD    TO    THE    SPINAL    CORD.        53 

in  the  upper  parts  of  the  cervical  region  than  in  the  dorsal  and 
lumbar  regions. 

23d.  The  anterior  columns  of  the  spinal  cord  everywhere  except 
in  the  upper  part  of  the  cervical  region  have  a  great  share  in 
voluntary  movements. 

24th.  The  decussation  of  the  conductors  for  voluntary  movements 
in  animals  seems  to  take  place  chiefly,  but  not  entirely,  where  the 
anterior  pyramids  cross  each  other. 

"When  we  compare  the  conclusions  above  mentioned  with  the 
results  of  recent  microscopical  researches  on  the  structure  of  the 
spinal  cord,  we  find  that  they  agree  very  well  as  regards  several  of 
the  main  points.  We  shall  not  insist  upon  this  subject  here,  but 
we  must  say  a  few  words  on  the  descending  fibres  which  enter  the 
cord  with  the  posterior  roots,  and  we  must  also  speak  of  the  decus- 
sation of  the  conductors  of  sensitive  impressions. 

As  regards  the  descending  fibres,  the  existence  of  which  we  had 
been  led  to  admit  nearly  six  years  ago,1  we  will  refer  our  hearers 
to  the  second  of  the  important  papers  of  Mr.  J.  Lockhart  Clarke,2 
in  which  these  fibres  are  described  and  represented  (Plates  XXIII. 
and  XXIV.). 

Vivisections  show  that  there  is  but  a  slight  decussation  of  the 
conductors  for  voluntary  movements  in  the  spinal  cord  in  animals, 
while  pathological  cases  seem  to  show  that  there  is  no  decussation 
in  man  of  these  conductors  in  this  organ  at  all.  Anatomy,  how- 
ever, teaches  that  the  anterior  roots  send  a  large  part  of  their  fibres 
transversely  across  the  cord,  so  that  many  fibres  of  the  anterior 
roots  of  the  left  side  decussate  with  as  many  fibres  of  the  anterior 
roots  of  the  right  side.  The  teachings  of  experimentation  and  of 
pathology  are  both  opposed  to  our  admitting  that  these  decussating 
fibres  are  all  voluntary  motor  conductors.  It  seems  extremely 
probable  that  many  of  these  fibres  are  employed  for  reflex  move- 
ments. 

How  is  it  that  there  is  not  an  evident  decussation  of  many,  if  not 
all,  the  fibres  of  the  posterior  roots  in  the  spinal  cord  ?  Vivisec- 
tions, and,  as  we  shall  show,  pathological  cases  establishing  posi- 
tively the  necessity  of  admitting  the  existence  of  such  a  decussation, 
it  seems  certainly  strange  that  we  do  not  see  a  manifest  and  con- 

1  See  Boston  Med.  and  Surg.  Journal,  Nov.  1852. 

2  Transactions  of  the  Royal  Society,  1853.  See  also  my  Journal  de  Physiologie, 
No.  I.,  Janvier,  1858,  Plate  I. 


51  THE    CENTRAL    XERVOUS    SYSTEM. 

siderable  decussation  between  the  continuations  of  the  fibres  of  the 
posterior  roots  in  the  spinal  cord.  It  may  be  that  some  of  the 
fibres  which  cross  each  other  in  front  of  the  central  canal  of  the 
cord  are  not,  as  now  admitted,  fibres  of  the  anterior  roots,  but 
fibres  of  the  posterior  ones,  which,  after  having  passed  obliquely 
from  the  posterior  parts  of  the  cord  into  the  anterior,  become  trans- 
versal there,  and  pass  horizontally  into  the  other  lateral  half  of  the 
cord.  But,  whatever  may  be  true  in  this  respect,  there  are  con- 
ductors connected  by  means  of  cells  with  the  fibres  of  the  posterior 
roots,  and  they  pass  from  one  lateral  half  of  the  cord  into  the  other 
one.  They  have  been  seen  and  described,  and  represented  more  or 
less  clearly,  by  most  of  the  micrographers  who  have  recently  pub- 
lished papers  and  plates  on  the  organization  of  the  spinal  cord. 
"We  will  name  only  E.  Wagner,  Lenhossek,  Schrceder  Van  der 
Kolk,  Bidder  and  his  pupils  (Kupfer,  Owsjannikow,  Metzler)  Still- 
ing, and  Gratiolet.  According  to  the  actual  teachings  of  micro- 
scopical examinations  of  the  spinal  cord,  many  of  the  fibres  of  the 
posterior  roots  reach  the  cells  of  the  gray  matter  on  their  own  side, 
and  these  cells  send  fibrils  to  cells  which  are  in  the  other  half  of 
the  spinal  cord,  and  these  last  cells  send  fibrils  upwards  towards 
the  encephalon.  This  organization  is  assuredly  sufficient  to  explain 
the  crossed  transmission  of  sensitive  impressions. 

Omitting  the  representation  of  the  cells,  we  give  a  diagramatic 
view  of  a  transversal  section  of  the  spinal  cord.  (See  Fig.  14.)  The 
fibres  of  the  posterior  roots  are  seen  to  pass  through  the  gray  mat- 
ter into  the  posterior  and  the  lateral  columns.  It  is  necessary  to 
understand  that  most  of  them  do  so  only  after  having  been  in  com- 
munication with  cells,  or,  rather,  that  we  consider  the  fibrils  ema- 
nating from  cells  as  the  continuations  of  the  fibres  of  the  posterior 
roots  in  connection  with  them. 

Pathological  cases,  as  I  will  now  begin  to  show,  bear  out  almost  | 
all  the  conclusions  I  have  just  related,  and  they  are  not  in  oppo- 
sition to  those  few  conclusions  which  they  do  not  prove.  Experi- 
ments on  animals  could  not  lead  to  certain  conclusions  which  I 
shall  be  able  to  draw  from  some  of  the  pathological  cases  I  intend 
relating. 

I  shall  first  examine  what  are  the  effects  of  alterations  or  injuries 
to  the  posterior  columns  of  the  spinal  cord.     It  is  necessary,  in  the 
first  place,  when  discussing  the  principal  circumstances  of  these  | 
cases,  to  take  notice  of  the  extent  of  the  injury.    In  the  experiments 
I  have  mentioned,  after  a  transversal  section  of  the  posterior  columns 


ILLUSTKATIVB   PATHOLOGICAL    CASES.  55 

there  is  hyperesthesia  in  the  parts  of  the  body  which  are  behind  the 
section ;  the  same  thing  exists  in  man,  after  either  a  section  of  the 
posterior  columns,  or  pressure  by  a  tumor,  a  piece  of  bone,  &c. 
But  there  is  much  less  hyperesthesia  when  the  posterior  columns 
are  altered  in  a  great  part  of  their  length,  even  when  the  posterior 
roots  and  the  gray  matter  remain  normal,  and  this  is  explained  by 
the  fact  that  many  conductors  of  sensitive  impressions,  which 
pass  for  a  short  distance  in  these  columns,  are  injured,  and,  although 
the  same  causes  of  hyperesthesia  exist  then,  as  after  a  simple  sec- 
tion, this  excess  of  sensibility  does  not  show  itself,  on  account  of 
the  diminution  of  sensibility  due  to  the  alteration  of  the  posterior 
columns.  There  is,  then,  a  kind  of  compensation  between  the 
causes  of  hyperesthesia  and  those  of  anesthesia,  so  that  the  degree 
of  sensibility  remains  nearly  normal. 

In  cases  of  alteration  occupying  a  great  length  of  the  posterior 
columns,  there  is  a  notable  diminution  in  the  power  of  standing 
and  of  walking,  and  when  the  affection  has  lasted  long,  there  may 
be  a  complete  loss  of  these  powers.  The  causes  of  this  weakness 
are :  1st.  That  the  posterior  columns,  as  we  shall  show  hereafter, 
are  the  principal  channels  for  the  excitations  which  produce  reflex 
movements,  so  that  when  they  are  altered  there  is  a  great  diminu- 
tion of  these  movements,  and  as  they  are  absolutely  necessary  for 
the  actions  of  standing  up  or  walking,  it  seems  very  plain  that 
these  actions  become  lessened  when  the  posterior  columns  are 
altered.  2d.  That  after  a  time,  when  an  alteration  exists  in  these 
columns,  the  amount  of  power  of  action  in  the  other  parts  of  the 
spinal  cord  diminishes. 

Besides  these  two  causes  of  weakness  of  the  lower  limbs,  there 
are  others,  when,  with  the  posterior  columns,  the  posterior  roots  of 
nerves  and  some  parts  of  the  gray  matter  and  of  the  lateral  columns 
are  altered.  This  was  the  case  in  the  pathological  facts  which 
Longet  has  collected  to  establish  his  view,  that  the  posterior 
columns  are  the  only  channels  of  sensitive  impressions  in  the  spinal 
cord.  AVe  will  show  that  the  case  he  relates  cannot  give  such  a 
proof;  and,  still  more,  that  in  some  respects  there  is  a  disagree- 
ment between  the  views  he  held  and  the  facts  he  mentions. 

Case  1. — L was  admitted  in  December,  1823,  at  Bicetre,  for 

an  extreme  weakness  of  the  lower  limbs,  which  could  hardly  bear 
the  weight  of  the  body.  In  1825,  his  limbs,  which  were  atrophied, 
when  not  prevented  doing  so,  had  automatic  and  irregular  move- 


56  THE    CENTRAL    XERVOFS    SYSTEM. 

ments,  which  the  patient  could  not  control.  Sensibility  was  abso- 
lutely lost  everywhere  except  in  the  face.  He  did  not  feel  the 
coldest  objects. 

Autopsy. — The  whole  encephalon  without  alteration.  From  the 
origin  of  the  spinal  cord  to  its  termination,  its  posterior  half,  in- 
clusive of  the  gray  matter,  as  far  as  the  central  commissure,  was  con- 
verted into  a  yellow,  transparent  substance,  shining  like  a  solution 
of  gum,  and  resembling  gelatin  or  softened  horn,  without  any 
appearance  of  organization.  The  rest  of  the  cord  was  perhaps 
harder  than  the  pons  Varolii  is  normally,  but  it  had  no  other 
alteration.  The  anterior  roots  were  normal.  The  posterior  roots 
were  of  a  yellow- grayish  color  ;  they  shared  the  alteration  of  the  corre- 
sponding part  of  the  cord.  (Hutin,  cited  by  Longet,  Traite  tVAnat.  et 
de  Physiol,  du  Syst.  Xerv.,  1843,  vol.  i.  p.  346.) 

This  fact  is  certainly  in  opposition  to  the  views  of  Longet  and 
of  those  who  contend  that  the  antero-lateral  columns  of  the  spinal 
cord  are  the  only  channels  for  the  orders  of  the  will.  Before  the 
appearance  of  choreic  movements  in  this  case,  there  was  an  extreme 
weakness  in  the  lower  limbs,  and  the  antero-lateral  columns  were 
not  altered,  except  that  they  were  a  little  harder  than  in  a  perfectly 
normal  condition.  The  loss  of  sensibility  cannot  account  for  this 
weakness.  In  cases  of  complete  anaesthesia  without  paralysis  of 
movements,  as  we  shall  show  hereafter,  there  is  no  weakness,  but  a 
difficulty  or  a  complete  impossibility  of  guiding  the  voluntary  move- 
ments, unless  the  patient  looks  at  the  limbs,  in  which  case  he  can 
execute  any  movement.  In  the  above  case  the  lower  limbs  could 
hardly  bear  the  weight  of  the  body ;  it  is  not  so  with  patients  who 
have  lost  only  sensibility. 

As  regards  the  value  of  the  case  for  the  question  at  issue  in 
relation  to  the  transmission  of  sensitive  impressions,  the  posterior 
roots  being  altered,  the  case  cannot  prove  anything  concerning  the 
posterior  columns.  Dr.  E.  B.  Todd1  has  already,  with  great  pro- 
priety, stated'  that  in  cases  capable  of  proving  anything  in  this  re- 
spect the  posterior  columns  must  be  altered,  while  the  posterior 
roots  and  the  antero-lateral  columns  are  not.  To  this  we  will  add 
that  the  gray  matter  also  must  not  be  altered. 

Case  2. — A  woman,  partially  paralyzed  of  sensibility  and  mo- 
tion, dies   from    a   disease   having   no  relation   to    the  paralysis. 

1  Cyclopaedia  of  Anatomy  and  Physiology,  vol.  iii.  p.  721,  P. 


ILLUSTRATIVE    PATHOLOGICAL    CASES.  57 

Several  times  I  had  endeavored  to  make  her  walk ;  but  her  in- 
ferior limbs  gave  way,  and  were  entirely  unable  to  support  her. 

Autopsy. — The  two  posterior  columns  are  converted  into  a  soft 
gray-pinkish  pulp,  rich  in  bloodvessels.  The  alteration  diminished 
gradually  from  the  lower  to  the  upper  regions  of  the  spinal  cord, 
and  it  stopped  at  about  an  inch  from  the  nib  of  the  calamus.  In 
the  lower  part  of  the  cord  the  alteration  had  begun  to  invade  the 
lateral  columns  in  the  neighborhood  of  the  posterior  ones.  The 
posterior  roots  of  nerves  were  very  thin,  particularly  in  the  lower  part. 
The  rest  of  the  spinal  cord  was  perfectly  healthy.  The  whole  en- 
cephalon  was  in  the  most  perfect  condition.  (Cruveilhier,  cited  by 
Longet,  loco  cit.,  vol.  i.  p.  347.) 

In  this  case,  also,  we  find  the  posterior  roots  altered,  and,  there- 
fore, the  diminution  of  sensibility  cannot  be  attributed  to  the 
state  of  the  posterior  columns.  As  regards  movements,  we  see 
here  that  the  lower  limbs  were  not  able  to  bear  the  weight  of  the 
body,  although  the  alteration  had  attacked  only  a  very  small  part 
of  the  lateral  columns  besides  the  posterior. 

Case  3. — M ,  for  two  years  paralyzed.     In  the  beginning, 

numbness  in  the  lower  limbs.  Afterwards,  a  numbness  and  half- 
paralysis  appeared  in  the  upper  limbs.  To  keep  a  needle  between 
her  fingers  she  must  look  at  them.  Motion  is  diminished;  all  the 
movements  are  executed,  but  they  are  weak,  and  cannot  accomplish 
the  functions  for  which  they  are  designed.  The  lower  limbs,  which 
she  can  move  when  in  bed,  are  not  at  all  able  to  serve  for  the  verti- 
cal position. 

Autopsy. — Spinal  cord  small ;  a  pseudo-membrane  on  the  hind 
part  of  the  cord ;  gray  degeneration  of  the  posterior  columns  of  the 
cord;  atrophy  of  the  posterior  roots  of  nerves.  (Cruveilhier,  cited  by 
Longet,  loco  cit.,  vol.  i.  p.  349.) 

Here,  again,  the  posterior  roots  were  altered.  There  was  also 
such  a  weakness  that  the  patient  could  not  stand,  although  it  is 
stated  that  the  antero-lateral  columns  were  no  otherwise  altered 
than  is  implied  in  the  statement  that  the  spinal  cord  was  small. 
There  were  here  all  the  circumstances  which,  in  such  cases,  usually 
cause  the  impossibility  of  standing  on  the  lower  limbs. 

Case  4. — Miss  G ,  admitted  at  the  Salpetriere,  in  1825,  died 

in  1835,  having  never  been  out  of  bed  during  these  ten  years. 
After  several  years,  during  which  there  was  numbness  and  difficulty 


58  THE    CENTRAL    NERVOUS    SYSTEM. 

of  walking,  the  patient  was  confined  to  bed.  When  observed  last, 
she  had  disordered  involuntary  movements,  which  she  could  not 
control.  When  not  prevented  by  the  bed  sheets,  the  lower  limbs 
were  agitated  by  the  most  violent  and  irregular  movements.  These 
convulsions  were  produced  when  the  patient  attempted  to  move 
voluntarily.  The  upper  limbs  were  less  attacked  than  the  lower. 
The  muscles  of  the  face,  of  the  larynx,  and  those  employed  in  de- 
glutition and  respiration,  shared  also  in  the  disorder.  Sensibility 
was  very  obtuse;  pinching  and  pricking  were  perceived,  but  very 
slightly.  To  hold  a  pin  between  her  fingers  she  must  look  at  them. 
She  did  not  feel  an  eschar  on  the  sacrum. 

Autopsy. — Eed  softening  of  the  occipital  circonvolutions  of  the 
left  side  of  the  brain.  Brain  otherwise  healthy,  as  also  the  cerebel- 
lum and  medulla  oblongata.  The  spinal  cord  was  atrophied,  and 
reduced  to  two-thirds  of  its  ordinary  volume.  The  posterior  median 
columns  were  transformed  into  a  gray -yellowish,  indurated  strap  all 
along  the  spinal  cord,  and  extending  into  the  middle  of  the  cere- 
bellum. In  the  spinal  cord,  the  alteration  is  confined  only  to  the 
median  posterior  columns,  while  the  antero-lateral  columns  were 
perfectly  healthy.  The  posterior  roots  of  the  spinal  nerves  were  com- 
p)letely  atrophied;  they  were  transparent,  filiform,  and  quite  different 
from  the  anterior  roots,  which  had  their  normal  appearance  and 
volume.  (Cruveilhier,  cited  by  Longet,  loco  cit.,  vol.  i.  p.  355.) 

In  this  case,  the  posterior  roots  were  altered  with  only  a  part  of 
the  posterior  columns — the  median  columns.  It  is  strange,  to  say 
the  least,  that  such  a  case  has  been  presented,  as  proving  that  the 
posterior  columns  are  the  only  channels  for  sensitive  impressions ! 
We  will  point  out  the  atrophy  of  the  spinal  cord  as  being  a  suffi- 
cient cause,  with  the  choreic  movements  and  the  alteration  of  the 
posterior  roots,  to  prevent  walking  and  standing. 

Case  5. — A  woman  had,  at  first,  a  numbness  which  rendered  her 
walking  similar  to  that  of  a  drunken  man.  She  had  frequent  falls, 
and  in  one  of  them  she  broke  her  leg.  Three  months  afterwards  she 
was  paraplegic.  The  fracture  had  not  been  painful.  On  admission, 
she  had  a  complete  loss  of  sensibility  in  all  the  parts  of  the  body 
below  the  epigastric  region ;  but  she  felt  pain  in  the  bones  and  in 
the  joints  of  the  lower  limbs.  Frequently  she  had  cramps,  which 
were  painful  and  made  her  shriek.  Pinching  and  pricking  were 
not  at  all  perceived.     In  bed  she  executed  all  the  movements  of  exten- 


ILLUSTRATIVE    PATHOLOGICAL    CASES.  59 

sion  and  flexion  of  the  lower  limbs;  but  when  put  on  her  feet  and  held 
up  by  two  persons,  she  was  hardly  able  to  make  use  of  her  limbs 
to  support  herself.  Hardly  could  she  move  these  limbs  to  go  for- 
ward ;  they  gave  way,  crossing  each  other.  In  the  upper  limbs 
sensibility  was  diminished,  not  lost ;  voluntary  movements  were 
nearly  perfect. 

Autopsy. — Brain  perfectly  healthy.  The  alteration  of  the  spinal 
cord  was  exactly  limited  to  the  posterior  columns,  and  consisted  in 
the  transformation  of  the  posterior  columns  into  a  gray-yellowish 
transparent  substance.  It  occupied  the  whole  extent  of  these 
columns  in  the  lumbar  and  dorsal  regions;  but  it  became  narrower 
and  occupied  only  the  median  columns  in  the  cervical  region.  The 
antero-lateral  columns  and  the  gray  matter  were  perfectly  healthy. 
(Cruveilhier,  cited  by  Longet,  loco  cit.,  vol.  i.  p.  351.) 

In  this  case  there  is  no  mention  at  all  of  the  state  of  the  posterior 
roots.  The  case,  therefore,  cannot  be  of  use.  It  would  be  if  it  had 
been  stated  that  the  posterior  roots  were  healthy.  Perhaps  it  will 
be  urged  that,  had  they  been  found  in  an  abnormal  condition, 
Cruveilhier  would  have  stated  the  fact,  and  that  his  not  having 
spoken  of  these  roots  is  a  proof  that  they  were  in  a  normal  condi- 
tion. This  is  no  proof  at  all,  as  Cruveilhier  usually  speaks  of  the 
healthy  parts  as  well  as  of  the  altered  ones,  and  in  the  case  we  are 
examining,  he  states  that  the  brain  and  certain  parts  of  the  spinal 
marrow  were  healthy.  At  any  rate  we  shall  bring  forward  so 
many  facts  showing  that  the  posterior  columns  are  not  the  channels 
for  sensitive  impressions,  that  it  will  become  evident  that,  in  this 
case,  the  posterior  roots  of  nerves  must  have  been  altered. 

The  five  cases  above  related  are  all  those  which  Longet  has  pub- 
lished in  proof  of  his  views.  It  is  pretty  evident,  from  the  exami- 
nation of  the  circumstances  of  these  cases,  that  they  do  not  give  the 
least  support  to  these  views ;  and  we  may  safely  state,  that  the 
pathological  facts  mentioned  by  Longet  are  not  more  able  than  his 
experiments  to  prove  his  views.  Still  more,  as  regards  voluntary 
movements,  these  facts  are  certainly  in  positive  opposition  to  the 
view  that  the  antero-lateral  columns  are  the  only  channels  through 
which  the  will  acts  upon  muscles. 

We  pass  now  to  the  exposition  of  other  facts,  which  positively 
establish  that  the  transmission  of  painful  and  purely  tactile  impres- 
sions may  take  place  through  other  parts  of  the  spinal  cord  than 
the  posterior  columns. 


60  THE    CENTRAL    NERVOUS    SYSTEM. 

Case  6. — A  young  man  was  admitted  into  the  Charite  on  the 
10th  of  June,  1839,  under  the  care  of  M.  Bouillaud.  He  complained 
of  pain  in  the  left  shoulder  and  in  the  neck.  The  next  day  he 
could  not  turn  his  head.  There  was  no  paralysis  anywhere,  either 
of  motion  or  sensibility ;  but  the  left  upper  limb  was  weak.  Heat 
normal.  On  the  19th,  headache;  pulse  52-56.  No  paralysis,  but 
the  legs  were  weak.  On  the  22d,  intelligence  diminished;  senses 
affected.  No  trace  of  paralysis.  On  the  25th,  symptoms  of  menin- 
gitis; death. 

Autopsy. — The  lower  part  of  the  cervical  region  of  the  spinal  cord 
was  much  enlarged,  and  contained  a  cancerous  tumor  of  the  size 
of  a  large  olive,  around  which  the  nervous  substance  was  notably 
softer  than  elsewhere.  The  seat  of  the  tumor  was  in  the  posterior 
part  of  the  cord.  The  development  of  the  tumor  had  taken  place 
from  the  surface  of  the  sheath  of  the  cord.  The  tumor  being  taken 
away,  the  white  substance  of  the  spinal  cord  was  found  to  be  com- 
posed of  two  large  bands,  of  a  soft  consistence,  without  notable 
injection.  The  rest  of  the  spinal  cord  was  healthy.  The  roots  of 
nerves  were  normal.  Slight  inflammatory  alterations  in  the  ence- 
phalon.  (Henroz  and  Bouillaud,  in  the  Journal  des  Gonnaissances 
Medicates,  1844,  vol.  xi.  p.  40.) 

This  is  a  decisive  case,  although  the  description  of  the  condition 
of  the  spinal  cord  is  not  clear.  It  is  quite  certain  that  very  little 
if  any  part  of  the  posterior  columns  remained,  and,  nevertheless, 
sensibility  was  not  diminished.  Had  the  patient  been  observed 
sooner,  and  at  a  time  when  he  had,  for  three  weeks,  what  he  called 
rheumatismal  pains,  it  would  very  likely  have  been  ascertained  that 
he  had  hyperesthesia.  When  he  was  admitted  the  tumor  had 
grown,  and  had  produced  more  or  less  alteration  in  the  gray  matter, 
so  that  hyperesthesia  had  ceased.  This  case  is  excellent,  as  it 
shows  that  a  destruction  of  the  posterior  columns  in  a  small  part  of 
their  length  does  not  cause  a  paralysis  of  voluntary  movements. 

Case  7. — P.  N ,  a  soldier,  received  a  bayonet  wound  between 

the  twelfth  dorsal  and  the  first  lumbar  vertebra),  injuring  the  spinal 
cord.  After  several  bleedings  the  first  pains  diminished;  but,  on 
the  second  day,  and  till  his  death,  he  had  the  most  excruciating 
pains  and  violent  cramps  in  all  the  parts  below  the  wound.  The 
skin  of  the  lower  parts  of  the  trunk  and  the  surface  of  the  abdominal 
limbs  was  so  sensitive  that  one  did  not  dare  touch  him,  and  he  had 


ILLUSTKATIVE    PATHOLOGICAL    CASES.  61 

to  keep  himself  on  his  knees  and  hands.  He  died  on  the  seventh 
day,  without  having  had  any  paralysis. 

Autopsy. — The  existence  of  a  wound  of  the  spinal  cord  was  ascer- 
tained. There  was  an  inflammation  of  the  spinal  cord  and  its  mem- 
branes, and  also  of  the  brain.  (Gama,  Traite  des  Plates  de  Tete  et  de 
VEacephalite,  1830,  p.  318.) 

There  is  no  doubt  that,  in  this  case,  the  hyperesthesia  was,  in  a 
certain  measure,  the  result  of  the  meningitis  ;  but  as  this  inflamma- 
tion existed  all  along  the  cranio-spinal  cavity,  while  the  excessive 
hyperesthesia  was  limited  to  the  lower  limbs  and  lower  part  of  the 
trunk,  we  must  admit  that  there  was  another  cause  to  it.  Probably 
the  inflammation  of  some  of  the  nerves  originating  from  the  cord, 
in  the  neighborhood  of  the  wound,  contributed  to  the  hyperes- 
thesia; but  the  principal  cause,  most  likely,  was  the  injury  to  the 
spinal  cord  itself.  I  have  ascertained,  upon  animals,  that  a  wound, 
on  the  posterior  surface  of  this  organ,  is  followed  by  a  greater 
hyperesthesia,  in  the  lower  limbs,  when  it  is  made  in  the  middle 
of  the  enlargement  which  gives  nerves  to  those  limbs  than  when  it 
is  made  higher.  It  is  to  be  regretted  that  Gama  did  not  state  what 
was  the  extent  of  the  injury  to  the  spinal  cord,  but  it  is  evident 
that  the  posterior  columns  were  the  principal,  if  not  the  only  parts 
wounded. 

Case  8. — A  man  fractured  his  spine  in  the  cervical  region ;  he 
was  at  first  paralyzed  in  the  lower  and  upper  limbs,  and  he  lost 
sensibility,  almost  entirely,  in  the  left  limbs,  and  had  only  a  dimi- 
nution of  this  property  in  the  right  limbs.  Gradually  he  recovered 
sensibility  and  voluntary  movements,  and,  after  three  months,  being 
completely  cured,  though  weak  when  walking,  he  left  the  hospital. 
The  same  day  he  went  on  foot  to  a  distance  of  nine  miles  from 
Paris,  and,  on  his  return,  he  fell,  and  became  again  paralyzed  both 
in  motion  and  sensibility.     Nearly  two  weeks  after  he  died. 

Autopsy. — The  fracture  which  had  first  caused  a  paralysis  had 
produced  a  displacement  of  a  part  of  the  posterior  arch  of  the  fourth 
cervical  vertebra,  in  consequence  of  which  the  posterior  columns 
had  been  divided.  (See  Fig.  15.)  There  was  in  the  centre  of  the 
cord,  where  the  pressure  had  taken  place,  a  fibro-cellular  nucleus, 
chiefly  formed  by  the  pia  mater.  The  anterior  columns  of  the  cord 
evidently  existed,  but  the  posterior  seemed  to  be  interrupted  at  the 
place  of  the  flbro-cellular  nucleus.  The  gray  matter,  from  above 
and  from  below  the  injured  part,  extended  to  this  nucleus.  (Ollivier 


02  THE    CENTRAL    NERVOUS    SYSTEM. 

d'Angers,  Tralte  ties  Maladies  de  la  Moelle  Epiniere,  3d  edit.,  1837, 
vol.  i.  p.  294.) 

We  give  here  (see  Fig.  15)  a  reproduction  of  a  figure,  published 
by  Ollivier,  representing  the  extent  of  injury  in  this  case.  It  seems 
evident,  from  the  description  and  from  the  figure,  although  both 
are  obscure,  that  the  continuity  of,  at  least,  a  part  of  the  gray  matter 
and  that  of  the  anterior  columns  was  preserved;  but  the  posterior 
columns  entirely,  and,  probably,  a  part  of  the  lateral  columns  and 
the  gray  horns,  had  been  severed.  However,  sensibility  and  volun- 
tary movements  had  returned,  after  a  period  of  great  diminution. 
This  case  is,  undoubtedly,  an  excellent  one  to  show  that  the  poste- 
rior columns  are  not  the  channels  for  voluntary  movements  nor  for 
sensitive  impressions.  We  must  remark,  that  this  condition  of  the 
spinal  cord  had  not  been  produced  when  the  man  fell  down  and  be- 
came paralyzed  a  second  time.  He  had  then  a  fracture  of  the 
callus,  which  had  united  the  broken  parts  of  the  first  fracture,  and 
paralysis  was  probably  due  to  a  pressure  near  the  divided  portion 
of  the  cord. 

Case  9. — G ,  aged  fourteen,  admitted  into  the  Charlie,  under 

the  care  of  M.  Kayer.  From  his  childhood,  after  having  been  very 
ill,  the  four  limbs  of  this  patient  have  been  drawn  convulsively, 
and  kept  in  the  position  of  those  of  a  foetus  in  the  uterus.  He 
seems  to  be  completely  paralyzed.  Some  muscles  of  the  shoulders, 
however,  appear  to  have  voluntary  movements,  and  the  head,  eyes, 
larynx,  and  tongue  obey  the  orders  of  the  will,  as  also  most  of  the 
respiratory  muscles.  Energetic  spontaneous  or  reflex  convulsions 
take  place  in  the  four  limbs.  There  is  hyperesthesia  everywhere 
in  the  limbs  and  in  the  trunk.  He  shrieks  every  time  he  is  touched. 
Lately  convulsions  have  increased,  delirium  has  appeared,  and  death 
has  taken  place  eight  hours  after  the  state  of  exquisite  sensibility 
has  shown  itself. 

Autopsy. — There  were  various  alterations  belonging  to  a  very 
old  spinal  meningitis,  and  an  acute  cerebral  meningitis.  Tuber- 
cles upon  the  left  cerebral  lobes.  There  is  softening  of  the  pos- 
terior columns  of  the  spinal  cord  principally  at  the  level  of  the 
sixth  and  seventh  cervical  vertebra?;  the  softening  diminishes 
gradually  from  this  point,  and  ceases  at  the  level  of  the  third  or 
fourth  dorsal  vertebra,  and  at  the  medulla  oblongata. 

This  case,  which  I  witnessed  at  the  Charite,  in  1849,  is  a 
valuable  one,  as  regards  the  question  we  examine,  in  this  respect, 


ILLUSTRATIVE    PATHOLOGICAL    CASES.  63 

that  sensibility  was  not  lost  nor  diminished,  although  the  posterior 
columns  were  softened.  As  to  the  loss  of  movements  and  the 
morbid  increase  of  sensibility,  there  were  too  many  alterations 
sufficient  to  produce  them  for  us  to  try  to  show  what  relation  they 
had  with  the  softening  of  the  posterior  columns.  The  following 
case  is  very  much  like  the  preceding,  but  it  is,  in  sorrye  respects, 
more  important. 

Case  10. — Mr.  F.  F had  been  in  good  health  until  1837, 

when  he  had  an  attack  resembling  congestive  fever.  The  next 
year  he  had  a  similar  attack,  with  a  more  lasting  delirium.  His 
strength  did  not  return,  although  his  appetite  became  very  good. 
His  walk  was  peculiarly  unsteady  and  tottering.  Pulse  slow;  tem- 
perature of  skin  low.  Gradually  paralysis  came  on  in  both  the 
upper  and  the  lower  extremities.  Violent  counter-irritation  was 
employed,  and  he  got  better,  but  soon  became  worse  again.  In 
May,  1839,  he  began  to  complain  of  pain  in  the  joints,  and  soon 
after  the  pains  came  on  with  paroxysms  attended  with  spasmodic 
contractions  of  the  limbs.  Any  forcible  attempt  to  extend  the 
limbs  caused  immediate  spasmodic  contraction,  with  excruciating 
pain.  The  upper  and  lower  extremities  became  permanently  con- 
tracted, the  lower  more  than  the  upper,  in  which  the  spasms  were 
attended  with  less  pain.  He  could  use  his  fingers  to  a  certain  ex- 
tent, but  had  little  power  over  the  larger  joints.  The  knees  were 
drawn  up  towards  the  abdomen,  the  legs  bent  upon  the  thighs,  so 
that  the  heel  rested  firmly  upon  the  soft  parts  covering  the  tuber 
ischii.  The  surface  of  the  body  during  the  early  stages  of  the  con- 
tractions of  the  limbs  was  morbidly  sensitive,  so  that  the  approach 
of  a  person  caused  him  to  cry  out,  lest  he  should  be  hurt.  He  re- 
mained in  this  state  for  several  months,  with  little  amendment, 
except  a  gradual  diminution  of  pain.  Hectic  fever  set  in,  and  he 
died. 

Autopsy. — Various  alterations  of  the  cranium,  the  dura  mater, 
the  arachnoid,  &c.  Hardly  any  morbid  appearance  in  either  the 
pia  mater,  the  brain,  or  the  cerebellum.  Tuber  annulare  and  me- 
dulla oblongata  firmer  than  usual.  From  the  foramen  magnum  to 
the  first  or  second  dorsal  vertebras  all  the  membranes  of  the  spinal 
marrow  were  firmly  united.  The  spinal  cord  in  the  cervical  region 
very  soft;  on  its  hack  part  semi-fluid.  The  lower  end  of  the  spinal 
marrow  firmer  than  usual.  (McNaughton  in  American  Journal  of 
the  Medical  Sciences,  July,  1812,  pp.  57-63.) 


61  THE    CENTRAL    NERVOUS    SYSTEM. 

We  are  very  willing  to  admit  that  at  least  a  good  part  of  the 
morbid  excess  of  sensibility  in  this  case  was  due  to  the  meningitis, 
but  whatever  be  the  exact  truth  in  this  respect,  it  remains  certain 
that  sensitive  impressions  were  freely  transmitted,  and  the  autopsy 
showed  that  the  back  part  of  the  spinal  cord — i.  e.,  its  posterior 
columns— was  serai-fluid. 

Case  11. — A  woman,  for  mairv  months,  complained  of  headache. 
Four  or  five  months  before  admission  into  a  hospital  she  felt  weak, 
and  had  numbness  in  the  four  limbs,  with  vertigo,  and  diminution 
of  sight.  All  the  senses  were  somewhat  impaired.  No  facial  palsy. 
Yery  violent  headache ;  paralysis  not  very  marked ;  diminution  of 
the  general  sensibility;  the  muscles  of  the  neck  in  a  tetanic  spasm; 
respiration  embarrassed,  interrupted.  She  died  five  or  six  hours 
after  admission. 

Autopsy. — Encephaloid  tumor,  of  the  size  of  a  small  walnut,  in 
the  triangular  space  formed  by  the  left  processus  cerebelli  ad  pon- 
tem,  the  pons  Varolii,  and  the  restiform  body.  The  medulla  oblon- 
gata was  at  least  four  or  five  lines  larger  than  usual ;  between  the 
medulla  oblongata  and  the  processus  cerebelli  ad  pontem  there  was 
a  notable  quantity  of  softened  and  yellowish  nervous  matter,  chiefly 
from  the  left  restiform  body,  which  was  entirely  destroyed.  The 
fourth  ventricle  was  considerably  dilated  by  a  yellowish  serosity. 
(Cartier,  in  Bulletins  cle  la  Societe  Anatom.,  1810,  pp.  85-87.) 

This  case  is  extremely  important ;  here  is  a  complete  destruction 
of  the  assumed  sole  channel  for  the  sensitive  impressions  on  one  side, 
and  yet  sensibility  persists !  It  is  true  sensibility  was  diminished, 
but  the  diminution  existed  on  both  sides,  and,  therefore,  could  not 
depend  upon  the  destruction  of  one  of  the  posterior  columns  of  the 
medulla  oblongata,  and  there  were  alterations  enough  to  produce 
this  diminution  (notable  enlargement  of  the  medulla  oblongata, 
dilatation  of  the  fourth  ventricle,  &c). • 

Case  12. — A  woman,  aged  fifty-five,  began  in  1831  to  feel  great 
weakness,  with  extreme  pain  in  her  lower  limbs,  and,  from  time  to 
time,  spasms.  The  weakness  increased  gradually,  and,  after  a  few 
months,  the  patient  was  unable  to  stand  on  her  feet,  the  lower  limbs 
losing  all  voluntary  movement,  while  their  sensibility  remained 
entire.  In  January,  1832,  she  recovered  some  power  of  motion, 
but  after  two  months  the  paraplegia  returned,  and  with  it  acute 
pain  in  the  lower  limbs  and  abdomen.     In  October,  1833,  she  was 


ILLUSTRATIVE    PATHOLOGICAL    CASES.  65 

admitted  into  St.  Louis ;  her  lower  limbs  had  lost  all  movement : 


they  were  atrophied;  a  slight  "  contracture"  existed.  These  limbs 
retained  all  their  sensibility;  feelings  of  pricking  and  painful  sensa- 
tions seemed  to  originate  in  them.  The  bladder  and  rectum  were 
paralyzed.  Pain  became  so  violent,  that  it  prevented  sleep.  The 
"contracture"  increased,  and  the  heels  came  almost  in  contact  with 
the  thighs.  It  was  impossible  to  extend  the  legs.  No  new  symp- 
tom appeared,  and  death  occurred  on  the  26th  of  October,  1833. 
During  the  last  days,  however,  sensibility  seemed  to  be  slightly 
diminished  (emoussee)  in  the  paralyzed  limbs. 

Autojjsy. — Brain  and  cerebellum  healthy.  At  the  level  of  the 
second  dorsal  vertebra,  against  the  left  and  posterior  part  of  the 
spinal  cord,  there  was  a  tumor,  two  inches  long,  six  lines  wide, 
nearly  oval,  lying  longitudinally  between  the  two  sheaths  of  the 
arachnoid.  The  part  of  the  spinal  cord  upon  which  the  tumor  had 
pressed  was  reduced  nearly  to  two-thirds  of  its  normal  volume. 
It  seemed,  with  the  part  below  it,  to  be  softer  than  usual.  (Hardy, 
in  Archives  de  Medecine,  &c,  1834,  vol.  v.  pp.  229-233.) 

The  author  of  this  important  case  observes,  that  sensibility 
was~  slightly  diminished,  only  during  the  last  hours  of  life,  and 
that  the  conservation  of  this  property  is  "the  more  remarkable  as 
the  tumor,  situated  behind  the  cord,  compressed  principally  its  pos- 
terior part,  which,  according  to  modern  physiologists,  is  especially 
used  for  sensation." 

It  is  to  be  regretted  that  the  author  has  not  described  with  more 
precision  the  alteration  of  the  spinal  cord;  but  as  it  is,  however, 
this  case  shows  that,  although  the  posterior  columns,  and  one  of 
them  particularly,  were  much  altered,  if  not  destroyed,  the  trans- 
mission of  sensitive  impressions  continued  to  take  place.  Other 
parts  of  the  spinal  cord  must  also  have  been  altered,  and  to  this 
fact  we  attribute  the  loss  of  voluntary  movements.  We  will  try, 
by  and  by,  to  explain  why  any  alteration  of  the  spinal  cord,  and 
particularly  that  which  is  due  to  pressure,  so  often  produces  a 
paralysis  of  voluntary  movement,  and  allows  the  transmission  of 
sensitive  impressions  to  continue.  We  will  merely  state  now  that 
this  difference  between  voluntary  movements  and  sensibility  is  very 
well  known.  In  an  important  work  of  one  of  my  most  eminent 
hearers,  I  read,  that  "occasionally  the  loss  of  voluntary  power  over 
the  muscles  is  a  total  loss  of  sensibility  (in  cases  of  caries  of  the 
spine);  but  more  frequently,  while  the  former  function  of  the  nerves 
is  destroyed,  the  latter  remains  but  little  or  not  at  all  impaired." 

E 


6ft  THE    CENTRAL    NERVOUS    SYSTEM. 

(Sir  B.  C.  Brodie,  Patholog.  and  Surg.  Observ.  on  Diseases  of  the 
Joints,  p.  332.)  A  very  able  observer,  Dr.  W.  W.  Gull,  has  col- 
lected many  facts  establishing  the  truth  of  this  statement.  (Gulsto- 
nian  Lectures  on  the  Nervous  System. — Medical  Times,  1849.) 

The  following  case  is  very  important,  and  it  has  more  value  than 
most  of  those  we  have  related,  on  account  of  the  microscopical  exa- 
mination of  the  altered  parts  of  the  spinal  cord. 

Case  13. — A  woman,  aged  forty-seven,  on  admission  at  the  Sal- 
petriere,  on  the  11th  of  July,  1855,  gave  the  following  account: 
Three  years  ago,  after  a  violent  emotion,  she  had  a  feeling  of  numb- 
ness and  formication  in  the  upper  limbs,  more  in  the  left,  and  after- 
wards in  the  lower  limbs.  Gradually  weakness  came  in  all  the  left 
side,  and,  after  eight  months,  the  left  arm  could  not  hold  anything 
unless  she  looked  at  it,  while  the  right  was  only  weakened;  she  also 
had  violent  pains  in  the  spine  and  chest  with  a  feeling  of  burning. 
The  sensibility  of  the  skin  was  then  so  great  that  she  dreaded  the 
presence  of  any  one  by  her.  Galvanism  produced  an  amelioration 
in  her  condition,  but  a  vicarious  menstruation  by  the  anus  weakened 
her,  and  then  she  came  under  my  observation.  There  was  violent 
spontaneous  pain  and  an  extreme  sensibility  in  all  the  left  arm,  and 
between  it  and  the  spine;  touching  these  parts  made  her  cry  out. 
The  degree  of  morbid  sensibility  was  not  so  great  in  the  right  arm. 
Although  so  sensitive  for  painful  impressions,  these  parts,  and 
particularly  the  left  arm,  or  at  least  the  fingers,  had  lost  the  tactile 
sensibility.  Hyperesthesia  was  as  great  in  the  lower  as  in  the  upper 
limbs,  and  particularly  on  the  left  side;  the  feet,  however,  felt  numb. 
The  skin  of  the  face  was  the  seat  of  formication. 

Movements  of  the  left  arm  were  easy,  but,  if  she  did  not  look  at 
it,  she  would  drop  what  might  be  between  her  fingers.  The  move- 
ments of  the  right  arm  were  perfectly  free.  It  was  so  with  the 
lower  limbs ;  they  were  moved  easily  in  bed,  but  walking  was  pos- 
sible only  with  the  help  of  an  assistant,  as  there  were  weakness  and 
vacillation  in  the  lower  limbs.  The  pain  went  on  increasing,  and 
■diarrhoea  caused  death. 

Autopsy. — Brain  and  cerebellum,  carefully  examined,  were  found 
healthy.  No  alteration  of  the  membranes  of  the  cord.  The  pos- 
terior columns  were  altered  in  all  their  length,  from  about  one  inch, 
above  the  cervico-brachial  enlargement  to  the  lower  extremity  of 
the  organ.  They  were  yellow,  and  infiltrated  with  serosity.  On 
transversal  sections  it  was  ascertained  that  the  whole  thickness  of 


ILLUSTEATIVE    PATHOLOGICAL    CASES.  67 

the  posterior  columns  was  altered.  A  microscopical  examination 
of  these  columns  made  by  me  (Dr.  Luys)  and  by  Dr.  Charles  Robin 
showed :  1st,  a  considerable  amount  of  yellow,  spherical,  granular 
bodies,  mixed  with  broken  nerve-fibres,  and  a  small  number  of 
longer  nerve-fibres;  2d,  an  amorphous  matter  containing  many 
granulations,  amongst  which  several  were  fatty;  3d,  the  blood- 
vessels were  in  a  state  of  fatty  degeneration.  The  gray  matter  was 
normal,  except  that  there  was  more  fat  than  usual  both  in  the  cells 
and  in  the  amorphous  substance.  The  anterior  and  lateral  columns, 
and  also  the  anterior  and  posterior  roots  of  the  spinal  nerves,  were 
healthy.  (Luys  in  Oomptes  rendus  de  la  Societe  de  Biologie,  pour  1856, 
pp.  94-97.)   " 

This  case  is  important  in  many  respects.  In  the  first  place,  it 
shows  that  the  posterior  columns  are  not  directly  employed  in 
voluntary  movements,  as  we  see  that  the  movements  existed  when 
guided  by  sight  (tactile  sensations  and  reflex  actions  missing).  In 
the  second  place,  this  case  shows  hyperassthesia  (for  painful  impres- 
sions), and  therefore  the  transmission  of  painful  excitations,  con- 
tinuing to  exist,  although  the  posterior  columns  were  hardly  able 
to  have  a  share  in  this  function.  And  lastly,  this  case  would  seem 
to  show  that  the  tactile  impressions  are  transmitted  to  the  senso- 
rium  by  the  posterior  columns.  In  this  respect  the  case  is  in  oppo- 
sition to  several  others  that  I  have  mentioned,  and  still  more  to  a  few 
that  I  have  yet  to  relate.  In  the  long  and  detailed  account  given 
by  M.  Luys  there  are  some  facts  of  which  I  have  not  spoken,  which 
prove  that  there  were  some  cerebral  alterations  which  have  not 
been  detected  at  the  autopsy.  It  may  be  that  these  alterations  have 
caused  the  tactile  anaesthesia.  The  facts  I  allude  to  were,  a  paralysis 
of  the  motor  branch  of  the  trigeminal  and  of  the  facial  nerve  on  the 
two  sides  (more  on  the  left),  and  a  notable  diminution  of  sight,  with 
an  acoustic  hypersesthesia. 

I  do  not  think,  however,  that  an  alteration  of  the  posterior  columns 
occupying  such  a  length  as  in  this  case  could  exist  without  impair- 
ing the  transmission  of  sensitive  impressions ;  as  my  experiments, 
as  well  as  anatomy,  establish  that  a  number  of  fibres  of  the  posterior 
roots  pass  into  the  posterior  columns.  There  may  be  a  certain 
number  of  these  fibres  transmitting  tactile  impressions,  and  others 
transmitting  painful  impressions;  and,  therefore,  an  alteration  of 
the  whole  of  the  posterior  columns  in  the  length  of  the  dorso  lumbar 
enlargement,  for  instance,  ought  to  diminish  tactile  and  painful 
sensibility  in  the  lower  limbs.     If  we  see  that  there  is  no  appear- 


68  THE    CENTKAL    NEKVOUS    SYSTEM. 

ance  of  diminution,  this  depends  upon  the  fact  that  there  is  a  cause 
of  increased  sensibility  which  gives  more  than  what  is  lost. 

In  the  justly  celebrated  cases  of  Mr.  Stanley,  of  Dr.  Webster,  and 
of  Dr.  Bucld,  of  which  I  will  now  give  a  short  summary,  it  is  very 
probable  that  tactile  sensibility  persisted  as  well  as  painful  sensi- 
bility. 

Case  14. — J.  C ,  aged  forty-four,  admitted  into  St.  Bartholo- 
mew's Hospital  for  paraplegia.  The  patient  was  lifted  into  a  chair, 
and  when  thus  sitting,  he  did  succeed,  by  a  great  effort,  in  raising 
his  legs  from  the  ground;  but  afterwards  the  inability  of  motion 
became  complete  through  each  lower  limb  in  its  entire  extent. 
There  was  no  discoverable  impairment  of  sensation  in  any  part  of 
the  limbs ;  on  scratching,  pricking  and  pinching  the  shin,  nowhere  was 
any  defect  of  feeling  acknowledged  by  the  patient.  In  the  upper 
limbs  there  existed  no  defect  either  of  motion  or  sensation. 

Autopsy. — The  spinal  cord  was  the  only  seat  of  disease ;  mem- 
branes healthy.  The  posterior  half,  or  columns  of  the  cord,  through- 
out the  entire  length,  from  the  pons  to  the  other  end,  was  of  a  dark- 
brown  color,  extremely  soft  and  tenacious.  The  anterior  half 
exhibited  its  natural  whiteness  and  firm  consistence.  The  roots  of 
the  spinal  nerves  were  unaltered;  the  brain  was  healthy.  (Mr. 
Edward  Stanley,  in  Medico- Ghirurgical  Transactions,  1840,  vol.  xxiii. 
pp.  80-83.) 

This  case  is  undoubtedly  one  of  the  principal  that  I  have  to 
mention  against  the  view  that  the  posterior  columns  are  the  only 
channels  for  the  sensitive  impressions.  Many  things  are  united  here 
to  give  value  to  the  case.  In  the  first  place,  the  name  of  the  ob- 
server is  a  perfect  guarantee  of  exactitude  in  the  observation  of 
symptoms,  and  the  description  of  the  condition  of  the  nervous 
centres.  In  the  second  place,  the  color  of  the  softening  shows  that 
it  was  not  a  recent  one.  In  the  third  place,  the  patient  seems  to 
have  had  sensations  of  touch  (scratching)  as  well  as  sensations  of 
pain  (pricking  and  pinching.)  /'Throughout  the  progress  of  the 
case,"  says  Mr.  Stanley,  "  the  opinion  had  been  freely  expressed, 
that  it  was  one  of  disease  of  the  anterior  half,  or  columns  of  the 
spinal  cord."  So  that,  were  this  not  entirely  unnecessary,  we  should 
have  in  this  expectation  another  guarantee  of  correctness.  But  we 
must  say  that  there  are  details  which  we  should  have  liked  to  see 
mentioned,  and  that  there  are  circumstances  in  this  case  which 
render  it  probable  that   certain  alterations  have  escaped  notice. 


ILLUSTRATIVE    PATHOLOGICAL    CASES.  69 

We  are  not  told  when  the  last  examination  was  made  as  regards 
the  state  of  sensibility.  The  loss  of  movement  was  so  absolutely 
complete  that  there  was  certainly  some  other  alteration,  besides 
that  of  the  posterior  columns,  producing  it,  and  to  which  was  due 
the  difference  between  the  upper  and  the  lower  limbs.  However, 
one  clear  and  positive  fact  remains;  there  was  a  notable  alteration 
(and  one  of  long  standing)  of  the  posterior  columns,  and  sensibility 
was  not  lost.     We  shall  find  the  same  fact  in  the  following  case: — 

Case  15. — R.  H ,  a  sailor ;  on  admission  at  the  Seamen's 

Hospital,  his  lower  extremities  were  extended,  and  very  rigid, 
with  sensation  unimpaired,  except  slight  numbness  of  the  thighs. 
Voluntary  movements  completely  impossible  in  the  lower  limbs; 
reflex  convulsive  movements  very  powerful;  slight  convulsions 
(much  more  feeble  than  before)  could  be  excited  to  the  last ;  his 
intellect  remained  unimpaired,  and  sensation  in  the  lower  limbs, 
and  elsewhere,  unaffected. 

Autopsy. — There  was  a  curvature  of  the  spine  formed  by  promi- 
nence of  the  dorsal  vertebrae,  from  the  fourth  to  the  ninth  inclusive. 
The  posterior  columns  of  the  cord,  for  the  extent  of  about  two 
inches  in  the  portion  corresponding  to  the  curvature,  were  softened. 
The  tissue  was  not  diffluent,  but  became  flaky  and  partially  dis- 
solved when  a  small  and  gentle  current  of  water  was  poured  on  it. 
The  anterior  columns  were  scarcely,  if  at  all,  softened,  and  resisted 
considerable  traction.  The  cord  above  and  below  the  affected  part 
was  perfectly  healthy,  and  so  were  the  nerves,  even  those  arising 
from  the  softened  part.  (Dr.  W.  Budd,  Medico-  Chirurgical  Transac- 
tions, 1839,  vol.  xxii.  pp.  162-165.) 

The  condition  of  the  gray  matter  is  not  mentioned.  However, 
this  is  an  important  case,  showing  that  although  the  posterior 
columns  were  deeply  altered,  the  transmission  of  sensitive  impres- 
sions continued  to  take  place.  There  was  in  this  case  complete  loss 
of  voluntary  movements,  for  the  explanation  of  which  we  refer  to 
our  remarks  on  the  succeeding  case ;  but  we  must  say  that  there 
was  here,  for  a  long  period,  a  cause  of  difficulty  and  even  of  impos- 
sibility of  voluntary  movement — I  mean,  the  spasmodic  state  of  the 
muscles.  In  two  ways  the  spasms  act  to  prevent  the  will  from  pro- 
ducing movements:  whilst  they  exist,  they  oppose  a  direct  resist- 
ance to  the  will ;  and  after  they  have  ceased  to  exist,  the  muscular 
irritability  is  for  a  time  too  much  exhausted  to  allow  voluntary 
contractions  to  occur. 


70  THE    CENTRAL    NERVOUS    SYSTEM. 

"We  regret  that  we  have  not  time  to  speak  of  various  important 
circumstances  of  this  and  other  cases  observed  by  Dr.  Budd  or  by 
Prof.  Busk,  which  cases  are  recorded  in  the  very  interesting  paper 
of  Dr.  Budd  which  we  have  quoted. 

Case  16. —  W.  IT.  Gr ,  aged  thirty-six.   After  various  accidents 

and  epileptic  fits,  he  became  unable  to  walk  steadily  without  sup- 
port. He  became  better,  but  soon  had  a  relapse,  and  then  was 
entirely  deprived  of  the  use  of  both  legs  and  arms.  Ultimately  the 
muscles  of  the  abdomen  and  chest  were  also  affected.  Notwith- 
standing the  total  loss  of  power  over  all  the  muscles  situated 
below  the  neck,  the  sense  of  touch  still  continued  as  acute  as  ever 
throughout  the  entire  frame;  indeed,  the  cutaneous  surface  appeared 
occasionally  to  be  even  more  sensitive  to  external  impressions  than 
in  the  patient's  previous  good  health,  since  he  could,  for  instance, 
feel  most  acutely  the  slightest  change  in  the  temperature  of  the 
surrounding  atmosphere.  His  sense  of  feeling  was  so  accurate  that 
he  could  distinctly  tell  the  particular  part  of  his  body  to  which  the 
attendant's  finger  was  applied.  He  had  spasmodic  twitchings  of 
the  legs  attended  with  great  suffering. 

Autopsy — about  eighteen  hours  after  death.  Slight  and  unim- 
portant alterations  of  the  brain  and  its  membranes.  The  part  of 
the  spinal  cord  corresponding  to  the  three  or  four  lower  cervical 
vertebras  appeared  larger  than  usual,  felt  soft  and  pulpy,  and,  on 
being  divided,  its  substance  seemed  to  be  in  an  almost  diffluent 
state,  infiltrated  with  serum,  but  of  a  normal  color;  in  the  anterior 
and  posterior  columns  not  much  difference  was  observed  at  the 
first  superficial  examination  of  the  cord;  both  divisions  seemed  con- 
siderably softened,  infiltrated,  and  disorganized,  particularly  the 
posterior  columns.  Above  and  below  the  affected  part,  the  me- 
dulla spinalis  was  healthy  and  quite  natural  in  appearance.  Dr. 
Todd  made  a  microscopical  examination :  he  found  great  destruc- 
tion of  the  posterior  columns,  and  did  not  find  any  loss  of  substance 
in  the  antero-lateral  columns.  He  says  that  he  was  unable  to  detect 
any  trace  of  gray  matter.  (Dr.  J.  Webster,  in  Med.-Chir.  Trans., 
1843,  vol.  xxiv.  pp.  1-18.) 

This  case  differs  from  the  preceding  by  the  extent  of  the  injury 
to  the  posterior  columns,  and  here  we  find  hyperesthesia,  as  in 
cases  of  tumors  upon  these  columns,  or  after  their  transversal  sec- 
tion in   animals.     There  was,  however,  a  cause  of  diminution  of 


ILLUSTKATIVE    PATHOLOGICAL    CASES.  71 

sensibility  here,  otherwise  the  hyperesthesia  would  have  been 
much  greater.  If  we  were  to  take  for  granted,  as  it  might  be  con- 
cluded from  a  few  words  of  Dr.  Todd,  that  the  gray  matter  was 
destroyed,  we  should  have  to  admit  that  the  antero-lateral  columns, 
even  somewhat  altered,  are  sufficient  for  such  a  notable  degree  of 
transmission  of  sensitive  impressions  as  that  which  existed  in  this 
case.  But  I  will  remark  that  when  this  eminent  biologist  made 
his  examination  the  gray  matter  had  been  divided,  and  then  ex- 
posed for  some  time  to  the  action  of  the  atmosphere  on  a  July  day, 
and  then  the  specimen  had  been  put  in  spirits  and  kept  some  time 
longer,  before  it  came  into  the  hands  of  Dr.  Todd.  Although  it  is 
probable  that  the  gray  matter  was  more  or  less  altered  in  this  case, 
it  seems  certain,  from  what  is  shown  by  other  pathological  cases 
and  by  experiments,  that  it  had  not  entirely  lost  its  share  in  the 
transmission  of  sensitive  impressions.  A  striking  fact,  well  made 
out  by  Dr.  Todd,  is  that  the  antero-lateral  columns,  although  soft- 
ened, had  not  lost  their  structure.  The  loss  of  movement  in  this 
case,  in  the  lower  limbs,  did  not  depend  in  any  way,  upon  the  same 
cause,  as  in  Cases  1,  2,  3,  4,  5,  14,  &c,  and  the  alterations  in  the 
posterior  columns  in  the  cervical  region  cannot  have  produced  the 
loss  of  voluntary  movement  in  the  lower  limbs,  as  will  be  shown  in 
a  moment  by  a  case  I  will  relate.  The  real  cause  of  loss  of  move- 
ment probably,  therefore,  resided  in  alterations  in  the  antero-lateral 
columns  and  in  the  gray  matter.  The  question,  How  could  these 
alterations  have  destroyed  the  power  of  action  of  the  will  on  muscles 
without  rendering  impossible  the  transmission  of  sensitive  impres- 
sions? we  cannot  answer,  otherwise  than  by  stating,  as  we  have 
already  done,  that  any  cause  acting  on  the  whole  circumference  of 
the  spinal  cord  or  of  a  nerve  produces  very  much  more  easily  a 
diminution  or  a  loss  of  motor  transmission  than  of  sensitive  trans- 
mission, and  that  in  a  great  measure  this  difference  is  due  to  the 
difference  in  the  reagents  at  the  extremities  of  the  conductors :  for 
one  kind,  the  sensorium,  so  easily  acted  upon ;  for  the  other  kind, 
muscles  and  bones,  so  difficult  to  move. 

Case  17. — A  soldier  was  paralyzed  of  voluntary  movement  in 
the  upper  limbs  only.     He  had  not  lost  sensibility  anywhere. 

Autopsy. — The  posterior  columns  of  the  spinal  cord  were  altered 
in  structure  between  the  fifth  cervical  and  the  third  dorsal  vertebras. 
They  were  softened,  and  this  alteration  gradually  diminished  from 


72  THE    CENTRAL    NERVOUS    SYSTEM. 

the  surface  to  the  centre  of  the  cord.  The  posterior  roots  also  were 
altered.  (Malle,  in  Clinique  Chirurgicale  de  VHopital  de  Strasbourg. 
1838.) 

This  case  is  unfortunately  without  details,  and,  for  instance,  it  is 
not  stated  when  sensibility  was  ascertained  to  exist.  But,  at  any 
rate,  we  find  here  an  alteration  of  the  posterior  half  of  the  spinal 
cord,  with  a  loss  of  voluntary  movements  in  the  limbs  alone  that 
correspond  with  the  part  altered.  The  action  of  the  will  on  the 
muscles  of  the  lower  limbs  had  continued  to  take  place  through  a 
spinal  cord  altered  enough  to  prevent  voluntary  movements  in  the 
upper  limbs.  As  regards  the  posterior  roots  of  the  cervico-brachial 
nerves,  which  are  said  to  have  been  in  a  state  of  putrilaye,  it  is 
certain  that  they  must  have  lost  at  least  a  part  of  their  power  of 
transmitting  sensitive  impressions;  and  this  proves  that  the  last 
examination  of  the  patient,  when  sensibility  was  found  existing  in 
the  upper  limbs,  must  have  been  made  a  somewhat  long  time  before 
death.  But  in  this  case,  as  well  as  in  others,  the  loss  of  certain 
functions  has  more  value  than  the  conservation  of  others;  and  we 
find  voluntary  movements  lost  in  the  upper  limbs,  and  nothing  to 
explain  this  loss  except  the  alteration  of  the  posterior  parts  of  the 
cord — an  alteration  which,  for  some  time  at  least,  had  not  destroyed 
sensibility. 

Case  18. — A  woman,  aged  forty,  received  a  blow  on  her  back. 
Six  weeks  after,  she  felt  pain  starting  from  the  right  foot.  Gradually 
the  pains  extended  to  the  various  parts  of  the  limb,  and  after  a 
month  they  were  accompanied  with  spasmodic  contractions  and  a 
diminution  of  voluntary  movements.  She  walked  with  great  diffi- 
culty, even  with  the  help  of  a  stick.  There  was  no  alteration  in 
sensibility  nor  in  temperature  in  this  limb.  The  convulsions  ex- 
tended to  the  other  limbs  and  to  the  head,  and  the  patient  died. 

Autopsy. — Brain  normal;  cerebellum  a  little  softened;  no  menin- 
gitis ;  spinal  cord  healthy,  except  in  the  swelling  for  the  lower 
limbs,  which,  for  an  extent  of  eighteen  lines  and  a  depth  of  one 
line  in  its  posterior  part,  was  softened,  looking  like  cream  some- 
what rose-colored.  (Genest,  Clinique  de  Chomel,  in  Gazette  Jfedicale 
de  Paris,  1831,  p.  84.) 

We  have  no  remark  to  present  about  this  case,  except  that  there 
was  a  considerable  alteration  of  the  posterior  columns,  and  con- 
servation of  sensibility. 


ILLUSTKATIVE    PATHOLOGICAL    CASES.  73 

Case  19. — A  young  girl  died  after  having  been  paraplegic,  and 
without  having  lost  sensibility.  The  encephalon  was  in  a  normal 
condition,  except  that  the  corpora  geniculata  were  of  a  gray  color. 
The  spinal  cord  in  all  its  length  had  a  gray-rose  color  column 
formed  by  the  median  posterior  columns ;  the  rest  of  this  organ  was 
healthy.  (Cruveilhier,  in  Anat.  Pathol.,  32d  livraison,  p.  21.) 

It  is  quite  certain  that  the  loss  of  voluntary  movement  in  this 
case  cannot  be  attributed  (at  least  only)  to  the  alteration  found  in 
a  small  part  of  the  cord ;  but  we  relate  this  fact  (which  Cruveilhier 
has  published  without  any  detail)  because  it  shows  that  there  may 
be  an  alteration  of  the  little  median  posterior  columns  with  pre- 
servation of  sensibility. 

We  might  relate  a  great  many  other  cases  showing  that  altera- 
tions of  the  posterior  columns  do  not  produce  anaesthesia,  and  are 
often,  on  the  contrary,  attended  with  hyperesthesia.  For  the  sake 
of  brevity,  we  will  merely  point  out  a  few  circumstances  connected 
with  some  of  these  cases,  and  give  the  references  of  the  others.  In 
a  paper  by  Dr.  Ludwig  Tiirck  (Beobachtungen  iiber  das  Leitungsver- 
rnogen  des  Menschlichen  Ruckenmarkes,  1855),  there  is  a  case  of  old 
alteration  of  a  part  of  the  right  side  of  the  spinal  cord  extending 
between  the  origins  of  the  fourth  and  sixth  cervical  nerves.  In' 
certain  sections  the  alteration  occupied  a  part  of  the  lateral  column 
and  a  part  of  the  posterior  column  (see  Fig.  16,  al)-  and,  in  another 
section  (between  the  fifth  and  sixth  cervical  nerves),  it  occupied  the 
whole  of  the  right  posterior  column.  The  altered  parts  were  indu- 
rated, of  a  reddish-gray  color,  and  did  not  contain  a  trace  of  nerve- 
fibre.  This  alteration,  therefore,  had  produced  there  just  the  same 
result  as  a  transversal  section  of  the  posterior  column  and  of  a  part 
of  the  lateral  column  on  the  right  side.  Numerous  and  careful 
examinations  have  shown  that  the  hands  and  fingers  had  no  anaes- 
thesia. In  this  case  the  anterior  parts  of  the  spinal  cord  were  also 
altered  in  the  cervical  region,  so  that  the  transmission  of  sensitive 
impressions  must  have  taken  place  through  the  central  gray  mat- 
ter. The  last  examination  of  the  state  of  sensibility  unfortunately 
was  made  long  before  death ;  but  the  alteration  found  is  one  that 
occurs  very  slowly.  The  same  remarks  might  apply  to  another 
case  observed  by  the  same  pathologist.  The  two  internal  segments 
of  the  posterior  columns  (see  Fig.  17,  al)  were  altered  (and  without 
any  trace  of  nerve-fibre)  between  the  fifth  and  sixth  cervical  nerves, 
and  sensibility  to  touch  in  the  parts  animated  by  these  nerves  per- 
sisted. 


74  THE    CENTRAL    NERVOUS    SYSTEM. 

Dr.  E.  B.  Todd  says,  that  in  two  cases  which  occurred  in  King's 
College  Hospital,  under  his  own  care,  the  prominent  symptom  was 
impairment  of  the  motor  power,  without  injury  to  the  sensitive; 
yet  the  seat  of  organic  lesion  in  both  was  in  the  posterior  columns 
of  the  cord.  (Cyclopaedia  of  Anatomy  and  Physiol.,  vol.  iii.  p.  721,  P.) 

Serres  speaks  of  a  woman  who  had  been  paraplegic  for  two 
months,  and  had  sensibility  preserved  in  her  lower  limbs,  although 
the  posterior  columns  were  alone  altered,  and  in  three  places.  (Anat. 
Comparee  du  Cerveau,  vol.  ii.  p.  221.) 

H.  Nasse  mentions  a  case,  observed  by  Wittfeld,  in  which  a 
tumor  pressing  upon  the  posterior  columns  in  the  lumbar  region 
had  produced  a  paralysis  of  movement,  and  not  of  sensibility. 
(Unter suchung en  zur  Physiol,  und  Pathol.,  vol.  i.  p.  226.) 

Sandras  says,  without  any  more  detail,  that  he  has  seen  two  cases 
of  alteration  of  the  posterior  columns,  in  one  of  which  sensibility 
was  lost,  and,  in  the  other,  voluntary  movements.  {Journal  General 
de  Med.,  dx.,  1829,  p.  360.) 

M.  Nichet  relates  a  very  important  case,  of  which  we  shall  have 
to  speak  elsewhere,  in  which  sensibility  had  persisted,  although  the 
spinal  cord  had  been  reduced  to  a  thickness  of  two  lines  near  the 
medulla  oblongata,  the  gray  matter,  almost  alone,  seeming  to  exist. 
(Gaz.  Med.  de  Paris,  1835,  p.  534.) 

We  might  cite  many  other  cases  by  Hutin,  Prus,  Velpeau,  Bel- 
lingeri,  Liberali,  Colin,  Bourdon,  Ollivier,  Caron,  Hersent,  Fricault, 
Cruveilhier,  Guyon,  Goupil,  J.  "W".  Ogle,  &c,  in  which  sensibility 
has  persisted,  and,  sometimes,  has  been  much  increased,  although 
the  posterior  columns  were  the  only,  or  principal  seats  of  alteration. 

I  think  that  it  is  impossible,  after  such  a  mass  of  evidence,  not 
to  admit  that  if  the  posterior  columns  of  the  spinal  cord  convey 
sensitive  impressions  to  the  encephalon,  their  share  in  this  function 
must  be  extremely  slight. 

In  the  next  lecture,  before  speaking  of  the  pathological  facts 
which  prove  that  the  conductors  of  sensitive  impressions  decussate 
in  the  spinal  cord,  I  will  relate  some  facts  concerning  the  transmis- 
sion of  these  impressions  through  the  gray  matter,  and  discuss  some 
important  questions  on  the  diagnostic  value  of  anaesthesia  and 
hyperesthesia. 


<o 


LECTURE    VI. 

SOLUTION,  BY  PATHOLOGICAL  CASES,  OF  VARIOUS  QUESTIONS  RELATING 
TO  THE  TRANSMISSION  OF  SENSITIVE  IMPRESSIONS  THROUGH  THE 
SPINAL  CORD. 

Value  of  the  cases  related  in  the  preceding  lecture,  in  opposition  to  the  view  that 
the  posterior  columns  of  the  spinal  cord  are  the  only  channels  of  sensitive  im- 
pressions.— Cases  opposed  to  the  views  that  the  cerebellum  is  either  a  channel 
of  transmission  of  sensitive  impressions,  or  a  centre  of  perception  of  certain  sen- 
sitive impressions. — Cases  of  alteration  of  the  whole  spinal  cord,  with  conser- 
vation of  sensibility. — Is  an  alteration  of  any  part  of  the  spinal  cord  able  to 
produce  anaesthesia  alone  ? — General  remarks  on  anaesthesia  and  hyperaesthesia. 
— Cases  of  alteration  of  the  gray  matter  alone,  with  loss  of  sensibility  and  volun- 
tary movements. — Cases  which  seem  to  be  in  opposition  to  the  view  that  the 
gray  matter  is  the  principal  channel  of  sensitive  impressions. — Summing  up  of 
the  evidence  as  regards  the  share  of  the  gray  matter  in  the  transmission  of  sen- 
sitive impressions. 

Mr.  President  and  Gentlemen:  In  the  preceding  lecture  I 
related  a  great  many  cases  of  alteration  of  the  posterior  co- 
lumns of  the  spinal  cord,  in  which  sensibility  was  more  or  less 
completely  preserved,  and,  sometimes,  increased  instead  of  being 
lost.  It  would  be  easy  to  add  many  other  cases  having  the  same 
meaning  as  those  I  have  mentioned.  But  I  think  that  it  would  be 
useless  to  do  so,  because  what  I  wish  to  prove  may  be  considered 
as  more  than  sufficiently  established  by  the  facts  already  related. 
Besides,  when  I  come  to  the  subject  of  the  transmission  of  the 
orders  of  the  will  to  the  muscles,  I  shall  relate  two  or  three  of  the 
most  important  facts  concerning  the  posterior  columns  amongst 
those  that  I  have  not  previously  mentioned. 

Several  objections  might  be  urged  against  the  signification  of  the 
cases  I  have  narrated,  especially  those  in  which  there  was  a  soften- 
ing of  the  posterior  columns.  These  last  cases  might  be  considered 
as  valueless,  for  either  one  of  the  following  reasons,  or  several  of  them 
at  the  same  time — 1st.  That  the  softening  may  have  been  produced 
during  the  interval  which  has  preceded  the  last  examination  of  the 


76  THE    CENTRAL    NERVOUS    SYSTEM. 

patient  and  his  death.  2d.  That  the  softening,  very  slight  before 
death,  has  become  considerable  after  death,  in  consequence  of  a 
rapid  putrefaction.  3d.  That  numerous  cases  of  softening  of  the 
whole  thickness  of  the  spinal  cord  may  be  found  in  the  bodies  of 
individuals  who  have  not  presented  any  symptom  of  paralysis  of 
either  sensibility  or  motion;  and  that,  therefore,  if  the  softening 
had  existed  during  life,  and  at  the  time  the  persistence  of  voluntary 
power  and  sensibility  was  ascertained,  we  must  admit  that  the 
simple  physical  state  of  softening  is  not  essentially  capable  of  de- 
stroying the  functions  of  the  cord.  Against  the  signification  we 
give  to  cases  of  tumors  pressing  upon  the  posterior  columns,  it 
might  be  said — 1st.  That  pressure  may  exist  without  destroying 
the  structure  of  a  number  of  the  fibres  of  these  columns.  2d.  That 
a  new  organization  of  the  cord  may  be  produced,  in  cases  of  tumors 
slowly  developed,  and  that  this  organization,  of  which  we  shall 
have  to  speak  more  at  length  hereafter,  explains  the  persistence  of 
sensibility. 

These  objections,  and  particularly  those  relating  to  softening, 
are  of  great  importance,  and  they  certainly  may  throw  very  well 
grounded  doubts  on  the  value  of  some  of  the  cases  I  have  related. 
But  if  we  look  at  the  details  of  most  of  them,  we  find  that  both 
the  symptoms  and  the  alterations  may  furnish  evidences  against 
these  objections.  In  the  first  place,  of  the  kinds  of  softening  so 
well  characterized  by  Professor  Hughes  Bennett  {Pathological 
and  Histological  Researches  on  Inflammation  of  Nervous  Centres,  Edin- 
burgh, 1843),  the  white,  which  alone  can  be  a  result  of  post-mortem 
decomposition,  is  not  the  one  which  has  been  seen  in  the  cases 
which  we  have  noted.  In  the  second  place,  in  none  of  those  cases, 
except  perhaps  one,  have  the  patients  died  from  an  acute  and 
rapidly-mortal  softening,  neither  have  they  had  the  symptoms  of 
this  affection,  which  has  been  so  well  described  by  Calmeil  (in 
Journal  des  Progrte  des  Sciences  Medicales,  1828,  vol.  xi.  pp.  133-191). 
In  the  third  place,  most  of  these  patients  have  had  symptoms  which 
really  belong  to  alterations  of  the  posterior  columns,  and  not  to 
diseases  of  other  parts  of  the  cord  or  the  encephalon,  as  we  shall 
show  in  another  lecture.  In  the  fourth  place,  a  microscopical 
examination  has  been  made  in  several  of  the  cases  (Cases  13,  16, 
and  the  two  of  Dr.  L.  Tiirck),  and  the  posterior  columns  have  been 
found  in  such  a  condition  that  the  least  part  of  their  normal  actions 
could  scarcely  persist. 

As  regards  cases  of  pressure,  the  objections  cannot  be  applied  to 


VALUE  OF  THE  ILLUSTRATIVE  CASES.         77 

most  of  them,  especially  to  Cases  7,  8,  11,  and  to  others  which  I 
have  not  time  to  relate,  and  which  are  recorded  by  Cruveilhier, 
Colin,  Wittfeld,  &c. 

Certainly  it  seems  quite  evident,  from  the  cases  we  have  related, 
that  the  posterior  columns  are  not,  as  they  have  been  called,  the 
sensory  tracts.  In  other  words,  they  are  not,  as  has  been  generally 
admitted  for  about  a  quarter  of  a  century,  the  reunion  of  the  sen- 
sitive fibres  of  the  posterior  roots  going  up  to  the  encephalon. 
Experiments  upon  animals  and  pathological  cases  agree  in  giving 
the  most  striking,  the  most  decisive,  proofs  in  this  respect.  But 
although  decisive,  according  to  my  conception,  these  proofs  per- 
haps might  be  considered  as  not  having  so  great  an  importance, 
by  those  who,  for  so  long  a  time,  have  held  a  contrary  opinion.  I 
will,  therefore,  give  other  arguments  against  this  opinion. 

It  is  positively  and  very  well  known  that  the  restiform  bodies, 
which  are  the  continuations  of  the  posterior  columns,  pass  chiefly 
into  the  cerebellum.  Now,  if  the  restiform  bodies  contain,  as  is 
supposed,  the  whole  of  the  conductors  of  sensitive  impressions 
coming  from  the  various  parts  of  the  trunk  and  limbs,  most  of 
these  conductors  must  go  into  the  cerebellum,  and  only  a  small 
number  pass  into  the  pons  Yarolii.  (See  Fig.  18, /and  f)  This  is 
what  "barred  the  progress"  of  Sir  Charles  Bell,  and  made  him 
abandon  the  idea  that  the  posterior  columns  of  the  spinal  cord  are 
the  channels  for  sensitive  impressions.1  Other  authors  have  not 
been  arrested  by  this  difficulty,  and  Longet2  has  imagined  that  the 
conductors  of  sensitive  impressions  pass  through  the  cerebellum 
and  go  out  of  this  organ  in  the  processus  cerebelli  ad  testes,  under 
which  they  decussate.  (See  Fig.  18.)  Foville3  has  admitted  an 
opinion,  which  had  been  already  held  by  Pourfour  du  Petit,  Sau- 
cerotte,  Sabouraut,  &c,  and  which  is,  that  the  cerebellum  is  the 
centre  for  the  perception  of  sensitive  impressions.  It  would  be 
easy  to  accumulate  a  great  many  facts  against  these  views.  We 
will  merely  mention  a  few,  referring  to  Andral,4  to  Toulmouche,5 
and  to  W.  Nasse,6  for  a  number  of  others. 

1  The  Nervous  System  of  the  Human  Body,  3d  edit.,  1844,  p.  239. 

2  Traite  d'Anat.  et  de  Physiol,  du  Syst.  Nerveux,  1843,  vol.  i.  pp.  420-21. 

3  Dictionn.  de  Med.  et  de  Chir.  Pratiques,  vol.  ii. ;  art.  "  Encephale,"  pp.  202-5. 

4  Clinique  Medicale,  2d  edit.,  vol.  v.  pp.  680,  700,  and  708. 

5  Gaz.  Med.  de  Paris,  1845,  p.  449. 

6  Comment,  de  Functionibus  Sing.  Partium  ex  Morborum  perscrut.  Indagatis, 
1847,  p.  52. 


78  THE    CENTRAL    NERVOUS    SYSTEM. 

As  regards  the  restiform  bodies,  we  have  already  related  a  case 
(Lecture  V.,  Case  9)  of  destruction  of  one  of  them,  with  conserva- 
tion of  sensibility,  and  we  will  merely  mention  now  that  there  are 
several  others  on  record,  two  of  which  (published  by  Velpeau  and 
by  Jobert)  we  shall  give  summarily  in  a  subsequent  lecture. 

As  regards  the  cerebellum,  Ave  find  sensibility  persisting  in  the 
celebrated  case  of  absence  of  this  organ,  recorded  by  Combette.1 
There  was  also  conservation  of  sensibility  in  two  other  cases  in 
which  the  cerebellum  had  been  totally  destroyed  by  suppuration; 
at  least  it  is  stated  that  there  was  no  paralysis  and  no  other 
trouble  in  the  functions  of  animal  life.  One  of  these  cases  having 
been  considered  as  impossible  by  Bouillaud,  who  read  a  report  about 
it,  at  the  Acade'mie  de  Medecine  of  Paris  in  1834  (see  Gaz.  Med.  de 
Paris,  1834,  p.  590),  Marc,  the  learned  physician  of  Louis  Philippe, 
rose  and  said  that  it  was  possible,  as  he  had  seen  an  exactly  similar 
case  at  the  Charite\ 

I  mention  the  above  cases  only  because  they  offer  instances 
of  destruction  of  the  whole  of  the  cerebellum.  Had  I  to  give 
more  proofs,  I  could  relate  a  very  large  number  of  cases  of  alter- 
ation or  destruction  of  either  or  both  lateral  lobes  of  the  cerebellum 
or  of  its  middle  part,  without  loss  of  sensibility  and,  frequently, 
with  hyperesthesia,  as  after  an  injury  to  the  posterior  columns  of 
the  spinal  cord. 

Another  and  good  method  of  proving  that  the  cerebellum  is  nei- 
ther a  place  of  passage  nor  a  centre  for  the  perception  of  sensitive 
impressions,  consists  in  showing  that  those  writers  who  admit  that 
this  nervous  centre  has  one  or  the  other  of  these  functions  do  not 
give  facts  in  its  favor,  and,  on  the  contrary,  acknowledge  that  there 
are  facts  in  opposition  with  it.  Thus,  Longet  (loco  cit,  pp.  748-54) 
adduces  many  cases  to  show  that  the  cerebellum  is  not  a  centre  of 
perception  of  sensitive  impressions,  and  he  does  not  perceive  that 
these  cases  are  as  much  opposed  to  his  own  view  that  the  sensitive 
impressions  pass  through  the  cerebellum!  Thus,  again,  Foville 
(loco  cit.,  p.  203)  insists  only  upon  one  case  to  prove  his  view.  It 
is  a  fact  observed  by  Morgagni,  in  which  a  boy  did  not  feel  pain 
when  his  back  was  cupped,  and  felt  pain  when  cupping  was  applied 
to  his  thigh.  There  was,  in  this  case,  two  spoonfuls  of  blood  effused; 
but  where?  Morgagni  says:  "At  sub  cerebello,  cujus  asquo  mollior 
est  visa  substantia,  in  medio  ferme,  atrum  concretum  sanguinem 

1  Magendie's  Journal  de  Physiol.,  vol.  xi.,  1831,  pp.  27-45. 


KELATIONS    OF    THE    CEREBELLUM    TO    SENSIBILITY.     79 

inveni  ad  duo  circiter  cochlearia."1  It  is  unnecessary  to  show  that 
a  case  of  this  kind  cannot  prove  anything.  Foville  relates  also  a 
case  of  tubercle  in  the  cerebellum,  with  hyperesthesia,  instead  of 
anaesthesia  {loco  cit.,  p.  202). 

Of  late,  a  much  more  rational  view  has  been  proposed  concerning 
the  relations  of  the  cerebellum  and  sensibility.  An  eminent  phy- 
siologist, Dr.  Carpenter,  at  first  suggested2  that  this  organ  is  pro- 
bably the  special  seat  of  the  so-called  muscular  sense  to  which  we 
owe  the  guidance  of  our  movements.  In  the  last  edition  of  his 
Human  Physiology,  he  explains  that  the  cerebellum  may  only 
react,  by  reflex  action,  upon  the  impressions  that  reach  it,  without 
being  itself  the  instrument  of  communicating  such  impressions  to 
the  consciousness.  Kecently  Mr.  K.  Dunn,  in  an  interesting  work,3 
has  adduced  a  case  in  proof  of  the  view  that  the  corpora  dentaia  of 
the  cerebellum  are  the  seat  of  the  muscular  sense.  In  a  child  there 
was  an  imperfect  paralysis  of  the  right  side,  both  of  the  arm  and 
leg,  but  still  they  responded  to  the  mandates  of  the  will ;  she  could 
move  her  arm  about,  and  could  grasp  anything  firmly  enough  in 
her  right  hand,  when  her  eyes  and  attention  were  directed  to  it ; 
but  if  they  were  diverted  to  something  else,  and  the  volitional 
power  withdrawn,  she  would  let  the  object  that  she  had  been  hold- 
ing fall  from  her  hand,  and  without  being  conscious  of  the  fact.  At 
the  autopsy,  there  was  found  in  the  lateral  lobe  of  the  cerebellum, 
on  the  left  side,  a  mass  of  tubercular  deposit  a  little  to  the  outer 
side  of  the  median  line. 

This  case,  certainly,  seems  to  be  a  valuable  one ;  but  what  can  it 
prove,  when  we  know  that  the  movements  have  remained  regular, 
and  consequently  well  guided,  in  many  cases  in  which  tubercles  or 
other  morbid  products,  or  various  alterations,  have  existed  at  the 
same  place  where  the  deposit  was  found  in  Mr.  Dunn's  case?  It  is 
to  explain  the  irregularity  of  movements  in  cases  of  injuries  to  the 
cerebellum  that  Foville  and  others  after  him  have  imagined  that 
the  guiding  power  of  our  movements  has  its  seat  in  this  organ; 
and  of  course  if  this  irregularity  exists  only  but  very  rarely,  and 
still  more  if  it  often  exists  in  cases  of  alteration  of  other  parts  of 
the  encephalon,  while  the  cerebellum  remains  normal,  we  must 

1  De  Sedibus  et  Causis  Morborum.  Nona  Ed.  Curant.  Chaussier  et  Adelon, 
vol.  i.  p.  187. 

2  Human  Physiol.,  5th  Anier.  edition,  p.  735. 

3  An  Essay  on  Physiological  Psychology,  1858,  p.  14,  note. 


80  THE    CENTRAL    NERVOUS    SYSTEM. 

reject  this  explanation.  I  have  ascertained  that  it  is  by  the  irri- 
tation they  produce  on  various  parts  of  the  basis  of  the  encephalon 
that  the  diseases  of  the  cerebellum,  or  its  extirpation  in  animals, 
cause  the  disorder  of  movements  which  has  been  considered  as 
depending  upon  the  absence  of  a  guiding  power.  In  fact,  the  least 
irritation  of  several  parts  of  the  encephalon,  writh  only  the  point 
of  a  needle,  may  generate  very  nearly  the  same  disorder  of  move- 
ments that  follows  the  extirpation  of  the  cerebellum.  I  have  thus 
been  led  to  conclude  that,  after  this  extirpation,  or  after  the  de- 
struction by  disease  of  a  large  or  small  part  of  this  nervous  centre, 
it  is  not  its  absence,  but  some  irritative  influence  upon  the  parts  of 
the  encephalon  that  remain  unaltered,  which  causes  the  irregularity 
of  movements.  In  birds  I  have  found,  long  ago,  that  the  mere 
exposure  of  the  rhomboidal  ventricle  of  the  lumbar  spinal  cord  is 
sufficient  to  produce  in  the  posterior  limbs  the  same  trouble  in  the 
gait  which  exists  after  the  extirpation  of  the  cerebellum.1 

I  have  seen  a  man  in  M.  Bayer's  wards  at  the  Charite'  who  had 
sensibility  to  touch,  to  pinching,  to  cold  and  heat,  and  also  the 
peculiar  feeling  produced  when  muscles  contract  spasmodically 
under  the  influence  of  galvanism ;  and  the  autopsy  showed  that  he 
had  a  tubercle  the  size  of  a  small  walnut  in  the  cerebellum,  near 
tjie  median  line,  in  the  upper  part  of  the  right  lobe.  (See  the  par- 
ticulars in  this  case,  published  by  M.  Tailhe,  in  the  Memoires  de  la 
Soc.  de  Biologie,  1849,  pp.  147-52). 

I  regret  not  to  be  able  to  expose  more  thoroughly  the  facts  and 
reasonings  which  are  opposed  to  the  views  that  some  kinds  of  sen- 
sitive impressions  reach  the  cerebellum  or  pass  through  it,  but  time 
urges  me  to  go  on,  and  I  must  now  come  to  another  question. 

In  a  sceptical  speech,  delivered  by  Gerdy,  at  the  Academy  of 
Medicine  of  Paris,  in  1839,  he  tried  to  show  that  there  is  no 
theory  concerning  the  transmission  of  sensitive  impressions  in  the 
spinal  cord,  which  is  not  proved  false  by  several  pathological  cases 
which  he  narrated.  Besides  these  cases,  there  are  several  others 
in  the  most  valuable  work  of  Abercrombie,2  and  in  a  paper  of  F. 
Nasse3  and  elsewhere,  most  of  them  having  the  following  characters: 
loss  of  voluntary  movements;  conservation  of  sensibility,  with  an 

1  See  my  work :  Experimental  Researches  applied  to  Physiology  and  Pathology, 
1853,  p.  79. 

2  Pathological  and  Practical  Researches  on  Diseases  of  the  Brain,  etc.,  fourth 
edition,  1845,  pp.  338-53. 

3  Untersuchungen  zur  Physiol,  und  Pathol.,  vol.  i.  pp.  226-229. 


ILLUSTRATIVE    PATHOLOGICAL    CASES.  81 

apparent  or  real  softening  of  the  various  parts  of  the  spinal  cord. 
We  will  briefly  examine  the  principal  features  of  these  cases. 

Case  20. — A  man  fell  from  the  second  story  of  a  house  and  broke 
his  back.  The  next  day,  the  two  lower  limbs  were  paralyzed,  the 
left  less  than  the  right;  sensibility  seemed  not  to  be  lost.  Twelve 
days  after,  sensibility,  which  had  seemed  to  be  limited  to  the  calves 
of  the  legs  (probably  existing  everywhere  above,  and  not  below), 
extended  to  the  upper  parts  of  the  feet.  On  the  twenty- third  day, 
sensibility  had  extended  to  the  extremities  of  the  toes,  but  the 
paralysis  was  complete.     Death  ensued  on  the  thirtieth  day. 

Autopsy. — Fracture  of  the  twelfth  dorsal  vertebra,  opposite  which 
the  spinal  cord,  which  was  healthy  elsewhere,  was  softened  and  of 
a  gray-yellowish  color.  (Ollivier,  Traite  des  Maladies  de  la  Moelle 
Epiniere,  third  edition,  vol.  i.  p.  498.) 

This  case  cannot  prove  much,  because  the  last  mentioned  exami- 
nation of  the  state  of  sensibility  was  made  seven  days  before  death, 
and  also  because  the  condition  of  the  gray  matter  is  not  mentioned. 

Case  21. — A  man  broke  his  back,  and  was  completely  paralyzed 
of  the  lower  limbs ;  until  his  death  he  had  an  obscure  sensibility 
in  all  the  paralyzed  parts. 

Autopsy. — The  twelfth  dorsal  vertebra  was  displaced,  and  pressed 
upon  the  spinal  cord,  which  was  flattened  and  softened  to  the  extent 
of  an  inch.     (Ollivier,  loco  cit.,  vol.  i.  p.  331.) 

This  case  shows  that  a  greater  alteration  of  the  spinal  cord  is 
necessary  to  destroy  sensibility  than  to  destroy  motion,  and  that  a 
softening  does  not  necessarily  prevent  the  passage  of  sensitive  im- 
pressions. 

Amongst  the  cases  of  softening  of  the  spinal  cord  recorded  by 
Abercrombie,  there  is  one  (Case  148)  of  a  man  who,  from  concus- 
sion of  the  spine,  lost  entirely  the  power  of  motion,  without  loss  of 
feeling.  About  a  month  after,  trismus  and  convulsions  came  on, 
and,  some  time  after,  death.  There  was  most  extensive  ramollisse- 
ment. 

The  cases  of  Abercrombie  are  interesting  in  showing  that  sensi- 
bility lasts  much  more  than  voluntary  movements  in  cases  of  soft- 
ening of  the  spinal  cord,  but  they  do  not  prove,  as  it  has  been 
assumed  by  some  persons,  that  a  softening  is  not  a  cause  of  loss  of 
function  of  the  spinal  cord.  In  several  of  these  cases  (particularly 
Cases  143  and  146),  there  was  loss  of  motion  without  loss  of  sensi- 

F 


82  THE    CENTRAL    NBBVOUS    SYSTEM. 

bility;  the  softening  was  much  more  marked  in  the  anterior  than 
the  posterior  columns.  Unfortunately,  nothing  is  said  of  the  con- 
dition of  the  gray  matter.  Case  147  is  that  of  a  gentleman  who, 
after  a  long  illness,  characterized  by  paralysis  and  various  other 
symptoms,  without  loss  of  feeling,  became  comatose  and  died.  The 
whole  cord  was  of  a  pale-rose  color,  and  in  a  state  of  complete 
ramollissement  through  its  whole  extent,  being  in  every  part  entirely 
diffluent.  I  will  remark  that  we  do  not  know  what  was  the  real 
condition  of  the  various  parts  of  the  spinal  cord  in  this  case,  and 
that  no  conclusion,  therefore,  can  be  drawn  from  it. 

The  following  extremely  important  case,  carefully  recorded  by 
my  learned  friend  Dr.  Laboulbene,  shows  that  what  would  have 
been  considered,  twenty  years  ago,  or  farther  back,  as  a  softening 
destroying  the  whole  thickness  of  the  spinal  cord,  may  be  only  a 
destruction  (and  not  a  complete  one)  of  the  white  substance  of  this 
organ. 

Case  22. — A  man,  aged  forty-four,  after  having  had  cramps, 
formication,  and  weakness  in  the  lower  limbs,  and  paralysis  of 
the  upper  limbs,  for  a  long  period,  was  admitted  at  Charite.  Sen- 
sibility existed  everywhere.  On  the  evening  of  the  1st  of  No- 
vember he  was  able  to  walk,  but  aided  by  some  one.  Sensibility 
continued  everywhere  to  the  last  moment  before  his  death,  on  the 
3d  of  November,  at  three  A.  M. 

Autopsy. — Encephalon  normal.  There  was  induration  of  the 
spinal  cord  from  its  upper  extremity  to  the  third  dorsal  vertebra, 
and  from  the  sixth  dorsal  vertebra  to  the  lower  extremity.  The 
tissue  of  the  cord  in  these  parts  being  cut,  was  shining,  looking 
like  porcelain,  hard  and  difficult  to  be  crushed.  The  gray  matter 
was  also  a  little  harder  than  normally,  but  of  its  usual  color.  The 
anterior  and  posterior  roots  seemed  normal.  In  the  space  between 
the  third  and  sixth  dorsal  vertebrae  the  cord  was  softened,  pultace- 
ous,  resembling  a  whitish,  or  rather  slightly  rose  pulp  (bouillie),  punc- 
tated in  some  places.  When  placed  in  water,  many  parts  became  dis- 
integrated, and  formed  a  kind  of  emulsion.  This  alteration  existed 
only  in  the  white  substance ;  the  gray,  on  the  contrary,  seemed  to 
have  preserved  its  normal  consistence.  The  microscope  showed 
that  the  gray  matter  in  both  the  softened  and  the  indurated  parts 
contained  normal  cells  and  fibres,  and  normal  bloodvessels,  while 
the  white  substance  in  the  softened  region  contained  but  rare  fibres, 
which  were  altered,  containing  an  oily  matter  and  granulations. 


ILLUSTEATIVE    PATHOLOGICAL    CASES.  83 

There  was  also  a  quantity  of  granulated  corpuscles  of  inflammation, 
with  many  capillaries,  oily  drops,  and  amorphous  matter.  In  the 
indurated  white  substance  there  was  less  alteration,  and  the  fibres 
were  more  normal  and  numerous.  (Laboulbene,  in  Memoires  de  la 
Societe  de  Biohgie,  pour  1855,  pp.  233-45.) 

The  author  of  the  report  of  this  case  adds,  that  he  has  ascer- 
tained that  sensibility  to  pinching,  pricking,  touching,  and  tickling, 
and  the  feeling  of  cold,  and  that  given  by  a  muscular  spasm  due 
to  galvanism,  persisted  in  this  patient,  although  the  white  matter, 
t.  e.,  the  posterior  and  the  antero-lateral  columns  had  but  few,  and 
only  altered  fibres.  A  capital  point  in  this  case  was  the  conserva- 
tion of  the  gray  matter  with  the  persistence  of  sensibilit}^. 

In  the  following  very  important  case,  we  find  quite  different 
features  from  those  of  the  preceding: — 

Case  23. — A  man  became  gradually  paralytic.  On  his  admission 
into  St.  Antoine,  he  was  completely  paralytic ;  sensibility  (to  prick- 
ing) at  first  lost,  but  after  a  time  it  returned  everywhere.  Tickling 
the  soles  of  the  feet  is  not  felt,  but  induces  reflex  movements.  Touch- 
ing was  not  felt  from  the  feet  up  to  the  middle  of  the  thighs. 

Autopsy. — Tubercular  matter  at  the  level  of  the  fourth  dorsal 
vertebra  pressing  upon  the  spinal  cord,  which  is  flattened,  very 
thin,  and  diffluent,  resembling  cream,  and  perfectly  white.  This 
part  of  the  spinal  cord  was  washed  away  by  a  stream  of  water. 
Below  this  part  the  spinal  cord  is  softened  in  an  extent  of  eleven 
centimetres  (three  inches  and  a  half) ;  above  this,  the  softening  ex- 
tends about  four  centimetres  (an  inch  and  a  third) ;  it  is  more 
marked  in  the  posterior  columns.  M.  Broca  made  a  microscopical 
examination.  He  states  that  the  gray  matter,  though  very  soft, 
seemed  not  to  differ  at  all,  as  regards  its  structure,  from  its  normal 
condition ;  and  the  same  thing  may  be  said  of  the  white  matter, 
except  that  the  tubes,  instead  of  being  straight,  presented  flexuosi- 
ties.  (Guyon,  in  Comptes  Bendus  de  la  Societe  de  Biohgie,  pour  1856, 
pp.  191-93.) 

We  must  remark,  that  this  was  a  case  of  white,  and  not  inflam- 
matory softening,  as  the  preceding,  and  that  the  autopsy  was  made 
only  thirty-five  hours  after  death,  in  August,  that  is,  in  warm 
weather.  The  interest  of  the  case  lies  in  the  fact,  that  although 
flattened  and  much  reduced  in  size,  the  spinal  cord  was  able  to 
transmit  painful  impressions,  while  it  was  incapable  of  transmit- 


81  THE    CENTRAL    NERVOUS    SYSTEM. 

ing  mere  tactile  impressions,  at  least  from  a  part  of  the  paralyzed 
limbs. 

In  the  following  case  we  find  almost  the  reverse : — 

Case  24. — A  young  man  had  symptoms  of  myelitis.  He  became 
completely  paraplegic,  and  he  lost  the  faculty  of  feeling  the  contact 
of  a  foreign  body,  unless  there  was  pressure,  in  which  case  he 
could,  usually,  say  what  place  was  touched.  Tie  did  not  feel  when 
pinched  or  pricked,  or  when  a  very  violent  galvanic  current  was 
applied  to  the  skin;  but  the  cold  of  a  metallic  vase,  and  also  the  least 
tickling  were  felt.  Spasms  induced  in  muscles  were  not  felt.  During 
the  last  days  of  life  tickling  was  no  longer  felt. 

Autopsy. — A  mass  of  tubercular  substance  had  partly  destroyed 
the  right  and  posterior  arch  of  the  fourth  and  fifth  dorsal  vertebrae, 
and  entered  the  spinal  canal  in  which  it  pressed  upon  the  posterior 
surface  of  the  cord.  This  organ  was  flattened  to  the  extent  of 
about  an  inch,  and  there  it  seemed  diffluent,  and  of  a  yellowish  color. 
M.  Yerneuil  made  a  microscopical  examination  of  this  softened 
part,  and  he  found  that  there  were  but  very  few  fibres,  and  they 
were  so  much  altered  that  it  was  difficult  to  ascertain  their  presence. 
There  were  many  inflammatory  granular  corpuscles. 

This  case  was  reported  to  the  Socie'te'  de  Biologic  in  1855, 
and  it  has  not  yet  been  published.  I  have  now,  all  its  history, 
written  by  M.  Fournier,  who  has  carefully  studied  the  interesting 
features  that  it  presents.  It  shows  that  certain  kinds  of  impressions 
may  still  be  transmitted  to  the  sensorium,  while  others  cannot  be, 
through  a  very  much  altered  spinal  cord. 

I  shall  not  pursue  farther  the  study  of  the  softening  of  the  entire 
thickness  of  the  spinal  cord.  My  object  in  speaking  of  the  above 
facts  will,  I  hope,  be  attained :  it  was  to  show — 1st.  That  in  cases 
where  the  cord  is  found  extremely  soft,  the  normal  structure  may- 
be preserved  (see  Case  23).  2d.  That  when  the  whole  thickness  of 
the  cord  seems  diffluent,  the  gray  matter  may  be  normal,  the  white 
substance  having  lost  its  structure,  and  that,  therefore,  the  persist- 
ence of  sensibility  may  be  explained.  3d.  That  it  would  be  wrong 
to  say  that  sensibility  does  not  persist  if  examinations  have  not 
been  made  to  detect  the  various  kinds  of  sensibility. 

Although  I  intend  to  treat  of  the  subjects  of  anaesthesia  and 
hyperesthesia  in  a  future  lecture,  I  will  say  a  few  words  now  of 
some  peculiarities  attached  to  these  two  symptoms.  In  the  first 
place  I  will  rapidly  examine  whether  anaesthesia  alone  may  be  pro- 


ILLUSTRATIVE    PATHOLOGICAL    CASES.  85 

duced  by  alteration  of  some  part  of  the  spinal  cord.  I  consider 
that  such  an  effect  is  absolutely  impossible,  and  just  as  much  as  it 
would  be  for  an  alteration  of  any  part  of  a  compound  nerve  (that 
is  a  nerve  containing  fibres  for  movement  and  for  sensation  mixed 
together)  to  cause  anaesthesia  alone.  The  cases  of  anaesthesia  which 
have  been  admitted  as  depending  upon  alterations  of  the  spinal 
cord — as  is  frequently  the  case  in  hysteria,  and  sometimes  after  a 
concussion  of  the  spine — I  will  prove  (or,  at  least,  give  arguments 
seeming  to  prove)  to  depend  upon  alterations  of  nutrition  in  the 
sensitive  nerves  of  the  skin  and  other  parts,  or  of  alterations  from 
various  causes  (tearing  in  cases  of  concussion,  &c.)  in  the  posterior 
roots  of  nerves,  or,  at  last,  of  encephalic  diseases.  There  is  only 
one  case  that  I  can  conceive  in  which  sensibility  might  be  lost  and 
movements  preserved  in  a  certain  affection,  or  a  peculiar  injury  of 
the  spinal  cord ;  but  I  hasten  to  say,  that  even  in  these  cases,  this 
organ,  though  divided  longitudinally,  must  remain  unaltered;  I 
mean  cases  of  spina  bifida,  and  cases  of  longitudinal  wounds  on 
the  median  line. 

Hyperaesthesia,  contrary  to  anaesthesia,  may  exist  alone,  and  this 
is  the  case  when  there  is  an  alteration  very  little  extended  in  the 
posterior  columns  of  the  spinal  cord,  or  in  the  cerebellum,  which 
we  may  consider  as  the  representative  of  these  columns  for  the 
pons  Varolii.  Most  frequently,  however,  hyperaesthesia  coexists 
with  a  loss  of  movements.  I  must  remark  that  we  must  not  con- 
found the  painful  sensations  that  have  existed  in  the  cases  of  altera- 
tion of  the  posterior  columns,  which  I  have  related  in  the  preceding 
lecture,  with  pains  sometimes  extremely  violent,  which  are  due  to 
the  irritation  of  both  or  either  the  posterior  roots  of  nerves  or  the 
spinal  cord,  in  cases  of  a  tumor  pressing  upon  them,  or  of  menin- 
gitis or  myelitis.  In  patients  who  are  completely  deprived  of  sen- 
sibility, there  may  be  the  most  violent  pains,  which  are  referred,  or 
not,  to  the  parts  which  are  anaesthetic.  The  following  case,  which 
I  owe  to  the  kindness  of  Dr.  Arthur  Farre,  is  a  good  illustration  of 
this  kind  of  affection. 

Case  25. — C.  K ,  aged  thirty-six.     After   having  suffered 

from  pain  in  his  back,  he  gradually  lost  the  power  of  motion  and 
the  sensibility  of  his  lower  extremities.  A  constant  pain  in  his 
back  prevents  him  from  sleeping.  On  one  occasion,  the  patient 
shrieked  with  agony  when  he  was  turned  upon  the  side  for  the  pur- 


86  THE    CENTRAL    NERVOUS    SYSTEM. 

pose  of  examining  the  back.  The  loss  of  sensibility  and  of  motion 
was  complete  in  all  parts  below  the  pelvis. 

Autopsy. — Outside  of  the  spine  there  was  a  large  tuberculous 
deposit.  The  vertebral  canal  being  laid  open,  an  oblong,  yellowish 
mass  was  found  on  the  posterior  part  of  the  sheath  of  the  cord, 
extending  over  the  third,  fourth,  and  fifth  dorsal  vertebrae.  The 
spinal  marrow  was  much  reduced  in  size  for  a  length  of  three 
inches,  in  consequence  of  the  pressure.   (See  Fig.  19,  a.) 

I  have  tried  to  prove,  by  a  great  many  pathological  cases,  that 
the  posterior  columns  are  not  the  only  channels  for  the  transmission 
of  sensitive  impressions;  I  will  now  try  to  prove  that  the  principal 
channel  for  these  impressions  is  the  gray  matter. 

Already  I  have  related  a  case  of  the  utmost  importance  for  this 
demonstration;  it  is  the  case,  so  carefully  recorded  by  M.  Laboul- 
bene,  in  which  sensibility  (every  kind  of  sensibility)  has  been  pre- 
served, although  the  gray  matter  alone  remained  to  establish  the 
communication  between  the  sensorium  and  many  parts  of  the  body. 
(See  above,  Case  22.) 

I  might  relate  several  other  cases  more  or  less  similar  to  this 
case  of  M.  Laboulbene,  but  I  hope  the  following  will  be  found 
sufficient. 

Case  26. — A  man,  aged  sixty-nine,  after  having  felt  some  pain 
in  the  lumbar  region  and  in  his  feet,  suddenly  lost  the  faculty  of 
speech;  left  side  of  the  face  paralyzed;  left  upper  limb  moved  with 
difficulty ;  the  other  limbs  free ;  sensibility  in  the  face  and  limbs 
unaltered.  A  few  days  after,  breathing  and  deglutition  difficult;  two 
days  after,  the  left  arm  had  still  a  part  of  its  voluntary  movements; 
its  sensibility  persists.  lie  passed  into  a  state  of  coma,  without  any 
increase  in  the  symptoms  of  paralysis. 

Autopsy. — Several  small  holes,  filled  with  a  kind  of  coagulated 
albumen,  in  the  encephalon,  which  is  otherwise  healthy.  From 
about  five  centimetres  (nearly  two  inches)  below  the  line  of  separa- 
tion between  the  pons  Yarolii  and  the  medulla  oblongata,  there  is 
a  white  softening,  which  descends  forty-eight  millimetres  (nearly 
two  inches)  lower,  and  occupied  the  posterior,  lateral,  and  anterior 
columns  of  the  cord.  A  current  of  water  broke  the  white  matter 
into  flaps,  and  more  so  its  posterior  than  its  anterior  part.  The 
gray  matter  is  hardly  altered.  (Prus,  in  Revue  Medicale  vol.  iv.  1840, 
p.  381.) 

In  another  case,  recorded  by  the  same  physician  {loco  cit.}  p.  391), 


ILLUSTKATIVE    PATHOLOGICAL    CASES.  87 

there  was  paraplegia  and  conservation  of  sensibility,  and  the  autopsy 
showed  a  softening  of  the  circumference  of  the  spinal  cord. 

Many  other  cases,  of  which  I  shall  have  to  speak  when  I  treat 
of  the  functions  of  the  medulla  oblongata,  have  the  same  bearing 
as  the  preceding.  They  show  that  pressure  all  round  this  nerv- 
ous centre,  having  destroyed  much  of  it,  but  having  left  a  good 
deal  of  its  gray  matter  uninjured,  has  allowed  the  transmission  of 
sensitive  impressions  to  take  place.  I  will  then  relate  cases  by  Mr. 
Lawrence,  Mr.  E.  Stanley,  Dr.  J.  W.  Ogle,  and  others. 

In  the  cases  I  have  just  been  speaking  of,  there  was  conserva- 
tion of  the  central  gray  matter  and  alteration  of  the  parts  near  the 
circumference  of  the  cord;  I  will  now  say  a  few  words  on  cases 
of  alteration  of  the  central  gray  matter,  the  rest  of  the  spinal  mar- 
row remaining  normal. 

In  cases  of  alteration  of  the  central  gray  matter,  sensibility,  ac- 
cording to  the  extent  of  the  disease,  is  diminished  or  lost.  The 
following  important  case  of  this  kind  is  reported  by  Mr.  Curling: — 

Case  27. — A  gentleman  suddenly  lost  all  sensation  and  power  of 
motion  in  the  lower  half  of  the  body.  Twenty-four  hours  after- 
wards there  was  a  feeling  of  numbness  in  the  hands  and  imperfect 
power  of  using  them.     No  reflex  movements. 

Autopsy. — Two  small  clots  of  blood,  amounting  together  to  about 
a  drachm,  were  found  in  the  interior  of  the  medulla,  occupying 
about  an  inch  and  a  half  in  extent,  and  situated  between  the  origins 
of  the  second  and  third  pairs  of  dorsal  nerves.  The  substance  of 
the  cord  around  the  clots  was  somewhat  soft ;  the  medulla  was 
more  or  less  infiltrated  and  stained  with  blood  from  the  site  of  the 
clots  upwards  as  high  as  the  third  cervical  vertebra,  and  down- 
wards as  low  as  the  last  dorsal.  {Report  of  the  Pathol.  Soc.  1849,  p. 
28,  cited  by  Messrs.  Handfleld  Jones  and  Sieveking  in  their  Manual 
of  Pathol.  Anat.,  1854,  chap,  xiii.,  American  edition,  p.  275.) 

It  is  useless  to  insist  on  the  value  of  this  case.  If  we  had  time, 
I  would  relate  also  a  case  of  hemorrhage  in  the  centre  of  the 
cord,  which,  though  more  complicated  than  the  preceding,  leads  to 
the  same  conclusion.  (See  Cruveilhier's  work,  Anat.  Pathol.,  3d  part, 
and  Plate  YI.)  In  another  case  of  effusion  of  blood  in  the  cord, 
the  softening  due  to  the  pressure  of  the  blood  was  central,  and  the 
anterior  and  posterior  parts  of  the  cord  were  not  affected,  and  there 
was  a  loss  of  sensibility  and  movement.  (Grisolle,  in  the  Journal 
Hehdom.  des  Progrte  cles  Scu  Med.,  1836,  p.  71.)     In  a  case  reported 


88  THE    CENTRAL    NERVOUS    SYSTEM. 

by  Ollivier,  there  was  a  tubercle,  olive-shaped,  and  ten  lines  long 
and  from  six  to  eight  lines  broad,  in  the  middle  of  the  spinal  cord, 
at  the  level  of  the  twelfth  dorsal  vertebra.  Around  this  tubercle 
and  elsewhere,  the  spinal  marrow  and  its  nerves  were  healthy. 
Sensibility  was  completely  lost  and  movement  almost  entirely  im- 
possible in  the  lower  limbs.  (Traite  des  Maladies  de  la  Motile  Epi- 
nitre,  vol.  ii.  p.  522.) 

There  are  some  pathological  cases  which  seem  to  be  in  opposition 
to  the  opinion  that  we  held  concerning  the  share  of  the  gray  matter 
in  the  transmission  of  sensitive  impressions.  We  will  try  to  show 
that  in  reality  they  have  not  a  great  value  in  this  respect. 

The  following  case,  recorded  by  Maisonneuve,  might  particularly 
be  advanced  as  a  proof  that  the  gray  matter  is  not  a  channel  of 
transmission  of  the  sensitive  impressions  : — 

Case  28. — A  woman,  aged  thirty,  had  been  in  good  health  till 
1829.  She  then  became  suddenly  exceedingly  weak  both  in  the 
upper  and  the  lower  limbs.  Three  weeks  after  the  paralysis  was 
completed.  In  1831  she  gradually  lost  the  power  of  feeling  in  the 
upper  limbs.  Respiration,  circulation,  and  digestion,  with  also  the 
excretion  of  urine  and  feces,  remained  normal.  In  February,  1833, 
respiration  became  painful,  symptoms  of  pneumonia  appeared,  and 
the  patient  died. 

Autopsy. — Brain,  cerebellum,  pons  Varolii,  and  medulla  oblongata 
healthy.  The  spinal  cord,  in  the  dorsal  region,  is  flattened  from 
behind  forwards;  when  rolled  between  the  ringers  it  is  found  to  have 
a  central  cavity.  In  blowing  into  this  cavity,  it  is  found  to  be  nearly 
eight  inches  (nine  English  inches)  long,  and  three  lines  in  diameter. 
This  canal  seems  to  be  formed  in  the  place  of  the  gray  matter 
which  is  missing ;  numerous  thin  filaments  are  found  in  the  canal, 
the  walls  of  which  are  one  line  thick,  and  very  firm  and  dense ; 
below  this  canal  the  spinal  cord  is  softened,  pulpy,  but  the  lumbar 
enlargement  is  almost  normal.  (Maisonneuve,  in  Revue  Mklkale, 
Juillet,  1833.) 

The  place  occupied  by  the  canal  is  not  stated  with  precision;  but 
the  symptoms  and  also  two  or  three  sentences  of  the  author,  which 
we  have  not  reproduced,  point  out  that  its  beginning  was  pretty 
near  the  decussation  of  the  anterior  pyramids — i.  e.,  in  the  upper 
cervical  region.  The  inferior  limit  was  in  the  dorsal  region,  two 
inches  above  the  lumbar  enlargement,  so  that  the  canal,  eight  or 
nine  inches  long,  occupied  more  than  the  whole  length  of  the 


ILLUSTRATIVE    PATHOLOGICAL    CASES.  89 

cervico-brachial  enlargement.  Now,  if  we  try  to  explain  the  symp- 
toms, we  find  that  the  upper  limbs  had  lost  their  sensibility,  which 
is  certainly  a  fact  in  opposition  to  the  view  that  the  posterior 
white  columns  are  the  only  channels  of  sensitive  impressions,  as 
these  columns  were  still  existing,  and  nearly  normal.  On  the  other 
hand  it  is  stated  that  the  lower  limbs  had  preserved  their  sensi- 
bility, but  it  is  not  said  how  many  days  or  weeks  before  death  this 
has  been  ascertained,  neither  what  its  degree  was,  nor  what  hinds 
of  sensibility  remained.  However,  let  us  accept  as  a  fact  that  the 
various  kinds  of  sensibility  at  a  notable  degree  persisted  till  the 
last  hours  of  the  life  of  this  patient.  By  what  channels  were  the 
sensitive  impressions  then  transmitted  ?  The  author  states  that 
the  walls  of  the  canal  were  one  line  thick,  so  that  we  are  entitled 
to  conclude  that  some  parts  of  the  gray  matter  still  existed  in  and 
along  the  posterior  and  anterior  horns,  and  also  lining  the  anterior 
surface  of  the  posterior  columns.  Besides,  my  experiments  (see 
Lecture  II.)  show  that  the  anterior  columns  have  a  share  in  the 
transmission  of  sensitive  impressions. 

Experiments  made  by  Magendie,  by  Sarlandiere,  and  others, 
show  that  the  passage  of  a  stylet  in  the  central  part  of  the  cord 
does  not  affect  in  a  marked  manner  the  sensibility  and  the  move- 
ments of  a  dog.  It  is  well  known  that  the  centre  of  this  organ  is 
occupied  by  a  canal,  lined  with  an  epithelial  membrane,  around 
which  is  a  good  deal  of  areolar  tissue  (the  ependyma  of  some  anato- 
mists). If  now  we  admit  an  effusion  of  blood  taking  place  slowly 
in  this  canal,  voluntary  movements  will  be  affected  more  or  less, 
because  any  pressure  on  the  cord  from  inside  or  from  outside  affects 
them,  while  sensibility  will  remain.  But  if  the  effusion  is  much 
increased,  there  is  a  considerable  pressure  and,  besides,  a  tearing  of 
the  parts  of  the  gray  matter  round  the  ependyma — and,  conse- 
quently, the  loss  of  voluntary  movements  becomes  complete,  or 
nearly  so,  and  sensibility  diminishes  or  is  destroyed  in  the  parts 
receiving  their  nerves  from  the  altered  region  of  the  cord.  If  the 
conductors  of  sensitive  impressions  decussate  near  the  centre  of  the 
cord,  as  I  will  prove  hereafter,  those  belonging  to  these  parts  are 
then  torn  away,  and  sensibility  is  consequently  lost  in  these  parts 
while  it  may  persist  in  parts  receiving  their  nerves  from  healthy 
regions  of  the  cord,  below  the  seat  of  the  alteration,  because  the 
conductors  of  sensitive  impressions  after  having  decussated,  in  these 
healthy  regions,  pass  in  the  altered  region  of  the  cord  further  from 


90  THE    CENTRAL    NEBVOUS    SYSTEM. 

its  centre  than  the  conductors  decussating  in  this  altered  part. 
This  explanation  of  the  above  case  receives  value  also  from  the 
results  of  one  of  our  experiments,  consisting  in  a  section  of  the 
decussating  conductors  of  sensitive  impressions  in  the  region  of  the 
cervico-brachial  enlargement,  after  which,  sensibility  is  lost  in  the 
upper  limbs  and  not  in  the  lower  ones.  (See  Lecture  III.,  and  Fig. 
11.)  In  the  above  case,  therefore,  I  think  that  the  loss  of  move- 
ment was  due  chiefly  to  the  pressure,  and  the  local  loss  of  sensi- 
bility to  the  tearing  of  the  crossing  of  the  conductors  of  the  sensi- 
tive impressions  upon  the  upper  limbs.  Viewed  in  this  light,  this 
case  is  quite  favorable  to  our  views,  instead  of  being  opposed  to 
some  of  them. 

Wishing  to  find  what  is  true,  and  not  to  try  to  establish  a  syste- 
matic view,  wrhich,  if  false,  wrould  sooner  or  later  be  put  down,  I 
have  been  hunting  much  more  for  cases  that  seem  to  be  in  opposi- 
tion to  the  theories  I  propose,  than  for  those  which  seem  to  sup- 
port them.  But,  however  extensive  have  been  my  researches  in 
this  respect,  I  have  hardly  found  two  or  three  cases  that  seem  to 
show  that  the  destruction  of  the  gray  matter  of  the  spinal  cord  may 
allow  sensibility  to  persist.  In. a  paper  of  Prus,  close  by  an  in- 
teresting case  in  which  sensibility  persisted  till  the  last  hours,  the 
white  substance  of  the  spinal  cord  being  alone  altered,  there  is 
another  case  in  which  there  was  paralysis  of  movement  alone,  and 
it  was  found  that  there  were  two  places  where  the  spinal  cord  was 
softened,  in  both  of  which  the  gray  matter  is  said  to  have  been  in- 
visible. (Prus,  in  Revue  Jlklicale,  1810,  vol.  iv.  p.  395.) 

I  will  merely  remark  that  the  mere  assertion  that  the  gray 
matter  wras  invisible,  cannot  be  considered  as  a  proof  that  this  sub- 
stance was  missing,  as  a  change  of  color  may  have  rendered  it  in- 
visible. Admitting,  however,  that  its  quantity  had  diminished, 
there  is  nothing,  in  the  short  details  of  the  autopsy,  showing  that 
there  was  a  total  absence  of  this  substance. 

I  shall  not  relate  here  cases  in  which  not  only  the  gray  matter, 
but  the  rest  of  the  spinal  cord  was  destroyed,  and  in  which,  never- 
theless, according  to  some  writers,  there  was  a  conservation  of 
voluntary  movements  and  sensibility.  I  shall  not  try  to  explain 
how  these  functions  and  properties  subsisted,  as  I  think  my 
hearers  are  too  enlightened  to  content  themselves  with  explanations 
like  those  of  Magendie,1  who  admitted  that  nervous  transmissions 

1  Journal  de  Physiol.  Exper.,  vol.  iii.,  1823,  pp.  187,  189. 


GRAY    MATTER    OF    SPINAL    CORD.  91 

took  place  through  the  membranes  of  the  spinal  cord,  or  of  M. 
Hutin,1  who  imagined  that  the  transmissions  continued  through  the 
serous  fluid  which  had  replaced  the  spinal  cord !  Before  trying 
an  explanation,  it  would  have  been  prudent  in  these  cases,  as  in  the 
celebrated  case  of  the  gold  tooth  in  the  last  century,  to  ascertain  that 
the  pretended  facts  were  positive.  We  are  perfectly  sure  that  no 
one  knowing  the  effects  of  a  transversal  section  of  the  spinal  cord, 
will  have  any  doubt  about  these  cases:  it  is  quite  evident  that  the 
greatest  part  of  the  alteration  found  in  this  organ  has  taken  place 
after  the  last  examination  of  the  patient. 

If  we  sum  up  the  evidence  that  the  gray  patter  of  the  spinal 
cord  is  the  principal  channel  of  transmission  of  the  sensitive  im- 
pressions, we  find — 

1st.  That  there  are  many  cases  of  alteration  only,  or  almost  only, 
limited  to  the  gray  matter,  and  in  which  both  voluntary  move- 
ments and  sensibility  have  been  lost.  To  the  cases  of  this  kind 
that  we  have  already  mentioned  (see  cases  recorded  by  Mr.  Curl- 
ing, Cruveilhier,  Grisolle,  and  Ollivier,  in  this  lecture).  We  will 
add  the  following  indications  of  similar  cases  which  are  eleven  in 
number;  one  by  Jeffreys,  quoted  by  Ollivier,2  one  by  Sir  Everard 
Home,3  one  by  Calmeil,4  one  by  Portal,5  and  a  most  remarkable 
one  by  Ollivier,6  which  we  shall  have  to  relate  by  and  by,  for 
another  and  interesting  feature  that  it  has  presented. 

2d.  That  there  are  many  cases  of  deep  alteration  of  all  the  white 
substance  of  the  spinal  cord,  the  gray  matter  remaining  normal,  in 
which  sensibility  has  persisted.  In  addition  to  the  cases  by  M. 
Laboulbene,  by  Prus  (Cases  22  and  26),  and  to  others  that  I  have 
related,  and  to  several  that  I  shall  have  to  relate,  I  will  merely 
mention  one,  recorded  by  Dr.  J.  Bostock,  in  which  the  whole  cir- 
cumference of  the  spinal  cord  had  been  pressed  upon,  so  as  to 
present  a  kind  of  circular  gutter,  and  in  which  sensibility  had  been 
preserved. 

From  the  cases  I  have  adduced  to  prove  my  views  concerning 
the  transmission  of  sensitive  impressions  in  the  spinal  cord,  it  may 

1  Nouv.  Biblioth.  Medicale,  1828,  vol.  i.  p.  159,  Obs.  13. 

2  Loco  cit ,  vol.  i.  p.  333.  3   Philosophical  Transactions,  1814. 

4  De  la  Paralysie,  Obs.  xlix. 

5  Anatomie  Medicale,  vol.  iv.  pp.  117,  118.  A  canal,  the  size  of  a  quill,  was 
found  in  the  spinal  cord. 

6  Loco  cit.,  vol.  ii.  p.  388. 


92  THE    CENTRAL    NERVOUS    SYSTEM. 

certainly  be  concluded — 1st.  That  the  posterior  columns  of  the 
spinal  cord  are  not  the  principal  channels  for  this  transmission,  and 
that  they  even  seem  not  to  convey  any  part  of  the  sensitive  impres- 
sions to  the  encephalon.  2d.  That  the  gray  matter  of  the  spinal 
cord  seems  to  be  the  principal  channel  of  transmission  of  the  sensi- 
tive impressions  to  the  encephalon.  These  two  principal  conclu- 
sions are  borne  out  also  by  the  experiments  related  in  my  second 
and  third  lectures. 


93 


LECTURE   VII. 

PATHOLOGICAL  CASES  SHOWING  THAT  THE  CONDUCTORS  OF  SENSITIVE 
IMPRESSIONS  FROM  THE  TRUNK  AND  LIMBS  DECUSSATE  IN  THE  SPINAL 
CORD  AND  NOT  IN  THE  ENCEPHALON,  AND  THAT  THE  CONDUCTORS  OF 
THE  ORDERS  OF  THE  WILL  TO  MUSCLES  DECUSSATE  IN  THE  LOWER 
PART  OF  THE  MEDULLA  OBLONGATA  AND  NOT  IN  THE  PONS  VAROLII. 

Tlie  decussation  of  the  conductors  of  sensitive  impressions,  from  the  trunk  and 
limbs,  does  not  take  place  in  the  crura  cerebri,  neither  in  the  pons  Varolii,  nor 
in  the  medulla  oblongata. — Cases  proving  that  this  decussation  takes  place  in 
the  spinal  cord. — Cases  of  loss  of  voluntary  movements  in  one  side  of  the  body, 
and  of  loss  of  sensibility  in  the  opposite  side. — The  decussation  of  the  con- 
ductors, for  voluntary  movements  does  not  take  place,  a3  has  been  imagined,  all 
along  the  basis  of  the  encephalon. — This  decussation  seems  to  take  place  almost 
entirely  in  the  lower  part  of  the  medulla  oblongata. — Symptoms  of  alteration  in 
a  lateral  half  of  the  spinal  cord,  the  lower  part  of  the  medulla  oblongata,  and 
the  rest  of  the  encephalon,  as  regards  voluntary  movements  and  sensibility. 

Mr.  President  and  Gentlemen  :  "We  now  come  to  the  ques- 
tions relating  to  the  place  of  decussation  of  the  conductors  of  sensi- 
tive impressions  in  the  cerebrospinal  axis.  In  one  of  the  preceding 
lectures,  I  have  related  the  experiments  by  which  we  have  been 
led  to  the  idea  that  this  decussation  takes  place  in  the  spinal  cord, 
for  most,  if  not  all,  the  conductors  of  sensitive  impressions  arising 
from  the  various  parts  of  the  trunk  and  limbs.  (See  Lecture  III.) 
I  will  now  try  to  show  that  the  same  view  seems  to  be  proved 
by  pathological  facts  observed  in  man. 

Anatomy  teaches  that  there  is  a  decussation  of  nerve-fibres  all 
along  the  spinal  cord,  the  medulla  oblongata,  the  pons  Varolii, 
and  the  crura  cerebri.  Let  us  see  what  would  take  place  in  cases 
of  disease  in  a  lateral  half  of  one  of  these  nervous  centres,  if  the 
decussation  of  the  conductors  of  sensitive  impressions  existed  in 
the  encephalon.  Admitting  that  it  is  in  the  crura  cerebri  that  these 
conductors  decussate,  as  Longet  has  imagined,  an  alteration  in  one 
of  these  peduncles  should  produce  a  diminution  of  sensibility  in 
the  two  sides  of  the  body,  because  conductors  belonging  to  these 
two  sides  should  then  be  injured,  those  of  the  right  side  being  in 


94  THE    CENTRAL    NERVOUS    SYSTEM. 

the  right  and  in  the  left  crura,  and  those  of  the  left  side  being  also 
in  the  left  and  in  the  right  crura.  This  view  does  not  agree  with 
pathological  cases,  which  show  that  an  alteration  in  one  of  the  crura, 
or  above  them  in  the  two  quadrigeminal  bodies  of  one  side,  causes 
no  diminution  of  sensibility  in  the  corresponding  side,  and  pro- 
duces anaesthesia  in  the  opposite  side.  So  it  was  in  cases  recorded 
by  Burnet,1  Andral,2  Mohr,3  and  Duplay.4  These  cases,  as  also 
several  others,  seem  to  show  conclusively  that  the  conductors  of 
sensitive  impressions,  in  their  way  to  the  brain  proper,  have  already 
made  their  decussation  before  they  reach  the  crura  cerebri  and  the 
basis  of  the  tubercula  quadrigemina.  Therefore  the  fibres,  which 
really  decussate  beneath  these  tubercles,  and  which  come  chiefly 
from  the  cerebellum  (see  Fig.  18,/),  cannot  be  considered  as  the 
conductors  of  sensitive  impressions. 

Is  it  in  the  pons  Varolii  that  the  decussation  of  these  conductors 
takes  place?  If  it  were  along  the  whole  length  of  this  organ,  we 
should  find  a  loss  of  sensibility  in  the  two  sides  of  the  body,  when 
one  side  only  of  the  pons  Varolii  is  altered,  because,  in  each  lateral 
half  of  the  pons,  there  should  be  conductors  belonging  to  the  two 
sides  of  the  body;  the  rigid  side  of  the  pons,  for  instance,  containing 
the  conductors  which  come  from  the  right  side  of  the  body,  in  their 
way  to  the  left  side  of  the  pons,  and  also  the  conductors  from  the  left 
side  of  the  body  after  they  have  passed  through  the  left  side  of  the  pons. 
Clinical  facts  do  not  agree  with  this  view,  as  they  show  that  anaes- 
thesia in  one  side  of  the  body  alone  is  the  result  of  an  alteration  in 
one  lateral  half  of  the  pons. 

The  same  reasoning  may  be  made  as  regards  the  medulla  oblon- 
gata. When  an  alteration  exists  in  one  lateral  half  of  this  organ, 
there  should  be  a  loss  of  sensibility  in  the  two  sides  of  the  body  if 
the  medulla  oblongata  were  the  seat  of  the  decussation  of  the  con- 
ductors  for  the  sensitive  impressions.  Pathological  facts  do  not 
leave  room  for  doubt  in  this  respect;  they  show  that  there  is  anaes- 
thesia only  in  one-half  of  the  body,  and  that  this  hemi-anaesthesia 
exists  in  the  side  of  the  body  opposite  to  the  side  injured  in  the 
medulla  oblongata. 

Imagine  an  injury  or  an  alteration  anywhere  you  choose,  near 

1  Journal  HeMomadaire,  1S29,  vol.  v.  p.  439. 

2  Clinique  Medicale,  2d  edit.,  vol.  v.  p.  32G. 

3  In  Casper's  Wochenschrift,  1840,  p.  479. 

4  Archives  de  Medecine,  &c.,  Nov..  1834. 


DECUSSATION"    OF    SENSITIVE    FIBRES.  95 

the  median  line  and  only  in  one  lateral  half,  from  the  upper  part 
of  the  crura  cerebri  and  the  tubercula  quadri  gemma  down  to  the 
medulla  oblongata;  and  if  this  injury  produces  anaesthesia,  it  is  in 
one  lateral  half  only,  and  this  half  is  the  opposite  one.  Now,  to 
point  out,  another  time,  but  in  other  words,  the  signification  of 
these  clinical  facts,  suppose  that  the  injury  is  in  the  crura  cerebri, 
the  hemi-anaesthesia  being  in  the  opposite  side  of  the  body,  it  results 
that  the  decussation  must  take  place  in  a  part  of  the  cerebro-spinal 
axis  situated  below  the  place  altered.  If  the  alterations  are  in  the 
upper,  the  middle,  or  the  lower  parts  of  the  pons,  on  one  side,  as 
the  decussation  must  take  place  below  the  seat  of  the  injury,  we 
are  led  to  the  conclusion  that  it  must  be  in  the  medulla  oblongata 
or  in  the  spinal  cord.  At  last,  in  examining  what  occurs  when  the 
injury  exists  in  the  medulla  oblongata,  we  find  that  the  decussation 
must  occur  in  the  spinal  cord. 

As  regards  the  spinal  cord,  we  find  also  that,  the  injury  existing 
in  one  lateral  half,  there  is  loss  of  sensibility  in  the  opposite  side. 
This,  of  course,  is  a  direct  and  a  better  proof  than  the  preceding 
that  the  conductors  of  sensitive  impressions  decussate  in  the  spinal 
cord;  but  the  cases  of  this  kind  are  not  numerous,  so  that,  to  give 
more  power  to  our  demonstration,  I  will  relate  the  cases  referring 
to  the  pons  Varolii  and  the  medulla  oblongata.  I  will,  there- 
fore, divide  into  two  series  the  cases  I  have  to  adduce  in  proof  of 
the  decussation  of  the  conductors  of  sensitive  impressions  in  the 
spinal  cord.  In  the  first  series  we  place  the  cases  of  alterations  of 
a  lateral  half  of  the  spinal  cord ;  and  in  the  second  series,  those  of 
alterations  of  a  lateral  half  of  the  medulla  oblongata,  the  pons 
Yarolii,  &c. 

First  Series  of  Gases  proving  that  the  Conductors  of  Sensitive  Impres- 
sions make  their  Decussation  in  the  Spinal  Cord. 

In  the  name  of  a  committee  of  the  Societe  de  Biologie,  we  have 
published  a  report  on  a  paper  by  Dr.  Ore,  of  Bordeaux,  in  which 
there  are  two  important  cases  observed  by  this  physician,  in  the 
Hospital  St.  Andre*  in  the  wards  of  Professor  Gintrac.  Here  is  an 
abstract  of  these  cases : — 

Case  29. — A  patient  was  admitted  into  the  St.  Andre  Hospital. 
He  had  a  paralysis  of  voluntary  movements  in  the  right  side  of  the 
body,  in  which  sensibility  was  preserved.     In  the  left  side,  on  the 


9(5  THE    CENTRAL    XERVOUS    SYSTEM. 

contrary,  the  voluntary  movements  existed,  but  there  was  a  great 
diminution  of  sensibility. 

Autopsy. — There  was  a  fungoid  growth  (vegetation  fun  gaide)  press- 
ing upon  the  right  lateral  half  of  the  spinal  cord.  (Memoires  de  la 
Societe  de  Biologie  pour  1854.) 

Case  30. — A  patient  had  lost  voluntary  movements  in  the  two 
limbs  of  the  left  side,  in  which  sensibility  was  preserved.  In  the 
right  side  sensibility  was  much  diminished  {trh  obtuse) 

Autopsy. — A  clot  of  blood  was  found  in  the  left  lateral  half  of  the 
spinal  cord  in  the  cervical  region.  (Memoires  de  la  Societe  de  Bio- 
hgie,  pour  1854.) 

These  two  cases  are  certainly  extremely  valuable,  and  they  agree 
perfectly  with  the  results  of  my  experiments  on  animals.  It  is 
so  also  with  the  following  cases: — 

Case  31. — A  man,  after  having  felt  a  sudden  pain  in  his  back, 
became  incompletely  paralyzed  of  voluntary  movements  in  the 
right  lower  limb.  Sensibility  was  not  altered  in  this  limb,  but  in 
the  left  side,  where  voluntary  movements  were  not  impaired,  sensi- 
bility was  entirely  lost  from  the  breast  to  the  foot. 

Autopsy. — Brain  and  its  membranes  normal.  In  the  spinal  cord 
an  hemorrhage  had  taken  place,  and  blood  was  found  in  the  right 
side  of  the  gray  matter,  having  destroyed  also  its  horns,  and  a  part 
of  the  right  anterior  column  in  the  dorsal  region.  (Monod,  in  Bul- 
letin de  la  Societe  Anatomigue,  No.  XYIIL,  p.  349,  Obs.  3,  and  in 
Ollivier,  loco  cit,  vol.  ii.  p.  177.) 

This  is  a  very  remarkable  case,  teaching,  not  only  that  there  is 
a  decussation  of  the  conductors  of  sensitive  impressions  in  the  spi- 
nal cord,  but  also  that  the  gray  matter  is  the  principal  channel  for 
these  impressions.  The  reporter  of  the  case,  M.  Monod,  I  hardly 
need  to  say,  is  one  of  the  best  surgeons  of  Paris.  I  subjoin  here 
three  figures,  representing  sections  of  the  spinal  cord,  to  show  the 
place  where  the  blood  was  found. 

If  we  had  time,  we  could  show,  by  some  details  of  this  case 
which  we  have  not  mentioned,  that  the  hemorrhage  was,  at  first, 
entirely  confined  to  the  gray  matter  of  the  right  side  of  the  spinal 
cord,  high  up  in  the  dorsal  region,  and  that  afterwards  the  blood 
destroyed  almost  the  whole  of  the  gray  matter  and  its  horns,  in  a 
great  extent,  in  that  same  side,  and  at  last  injured  a  little  the  cen- 
tral gray  matter  of  the  left  side.     Had  the  symptoms,  as  regards 


DECUSSATION    OF    SENSITIVE    FIBRES.  97 

movement  and  sensibility,  been  noted  after  the  first  days,  they 
would  have  been  somewhat  different  from  those  above  related.  In 
another  lecture  we  shall  have  to  speak  again  of  this  most  import- 
ant case. 

In  the  three  preceding  cases  there  is  no  mention  of  hyperes- 
thesia, although  it  must  have  existed  on  the  side  of  the  injury  in 
the  spinal  cord ;  we  shall  find  it  mentioned  in  the  following  cases, 
and  especially  in  the  next  one,  which  we  give  almost  in  full  on  ac- 
count of  its  extreme  importance: — 

Case  32. — On  the  4th  of  February,  1850,  a  man,  aged  twenty- 
eight,  was  admitted  into  the  St.  Louis  Hospital,  in  Professor  Nek- 
ton's ward,  a  short  time  after  he  had  been  wounded  by  a  police 
officer.  Besides  a  slight  wound  of  the  scalp,  he  had  been  wounded 
by  a  sword,  in  his  back.  The  point  of  the  sword  was  eight  milli- 
metres large;  there  was  a  transversal  wound  about  one  centimetre 
and  a  half  (half  an  inch)  between  the  ninth  and  tenth  dorsal  ver- 
tebrae, and  three  centimetres  (an  inch)  from  the  line  of  the  spinous 
processes.  A  physician,  who  had  seen  the  patient  at  once,  had  in- 
troduced a  stylet  in  the  wound,  and  ascertained  that  its  direction 
was  oblique  from  the  right  to  the  left,  and  a  little  upwards.  The 
patient  complains  of  slight  pains,  only  near  the  wound.  The  lower 
limbs  are  completely  deprived  of  voluntary  movements.  The  next 
morning  a  better  examination  is  made  ;  the  patient  has  not  slept ; 
he  has  suffered  violent  pains,  principally  in  the  left  lower  limb;  he 
feels  a  kind  of  burning  and  numbness,  as  if  he  were  receiving  elec- 
tric shocks.  The  sensibility  of  the  left  lower  limb  is  quite  evi- 
dently increased.  When  a  hand  is  simply  applied  upon  this  limb, 
the  pains  become  very  acute,  and  the  very  least  pressure  makes 
him  shriek  out.  This  morbid  state  of  sensibility  exists  in  the 
whole  length  of  the  limb,  and  also  upon  the  left  side  of  the  sacrum 
and  coccyx,  and  the  upper  and  anterior  part  of  the  thigh.  Higher 
up,  sensibility  is  normal.  Even  cold  air,  when  the  sheet  is  drawn 
down,  causes  pain  in  the  left  lower  limb.  Voluntary  movements 
are  impossible  in  all  this  limb,  except  in  the  toes,  which  can 
slightly  move. 

The  right  lower  limb  has  a  diminution  of  sensibility;  the  patient 
knows  when  he  is  touched,  but  when  pricked  with  a  pin  he  does 
not  feel  pain,  and  he  does  not  distinguish  a  pressure  by  the  finger 
from  the  pricking  of  a  pin.     In  both  cases  he  has  only  a  sensation 

G 


98  THE    CENTRAL    NERVOUS    SYSTEM. 

of  contact.  This  limb  is  not  deprived  of  movement  as  it  was  the 
previous  day.  The  flexion  of  the  foot  on  the  leg,  and  of  the  leg 
on  the  thigh,  are  executed;  the  movements  are  extensive,  but  the 
patient  cannot  altogether  lift  up  his  limb  from  the  bed. 

The  temperature  of  the  lower  limbs  is  the  same  as  that  of  the 
rest  of  the  body,  and  there  is  no  difference  between  those  limbs. 
All  the  organic  functions  are  in  a  normal  condition,  except  that 
there  is  a  retention  of  urine,  and  of  the  fecal  matters.  Voluntary 
movements  and  sensibility  are  not  altered  in  the  abdomen,  and  all 
the  upper  parts  of  the  body.  In  the  afternoon,  the  hyperesthesia 
has  extended  a  little  higher  on  the  left  side  in  the  upper  parts  of 
the  abdomen,  and  the  genital  organs  have  also  become  very  sensi- 
tive. When  a  cloth  that  has  been  dipped  into  water  at  30°  (pro- 
bably centigrade,  86°  Fahr.),  is  applied  to  the  left  limb,  the  patient 
has  a  feeling  of  burning,  which  makes  him  cry  out.  When  the 
cloth  has  been  dipped  into  water  at  the  low  temperature  of  the 
room,  the  patient  has  a  very  acute  feeling  of  cold. 

On  the  right  limb  the  wet  cloth  does  not  give  either  a  sensation 
of  warmth  or  cold,  or  of  dampness  or  dryness,  although  he  feels 
he  is  touched.  The  tickling  of  the  right  foot  is  not  felt  as  tickling, 
but  only  as  a  contact.  On  the  left  foot  tickling  is  exceedingly 
painful. 

Gradually  this  patient  became  more  and  more  able  to  move  the 
right  limb,  and  partly  also  the  left  limb.  The  hyperesthesia  dimi- 
nished, particularly  in  the  upper  parts  of  the  left  limb  ;  but  the  right 
limb  became,  for  a  time,  unable  to  feel  the  contact  of  a  hand,  and  if 
pricked  there  was  a  sensation,  but  the  patient  did  not  know  its 
place.  On  the  20th  of  February,  a  slough  was  found  on  the  right 
side  of  the  sacrum ;  the  patient  had  not  felt  anything  there.  In 
April,  voluntary  movements  had  returned  in  the  two  limbs,  but 
sensibility  was  still  deficient  in  the  right  one.  On  the  15th  of  June, 
the  patient  could  walk  with  the  help  of  a  cane,  and  he  left  the  hos- 
pital, not  having  yet,  however,  recovered  entirely  the  power  of  feel- 
ing, in  his  right  limb. 

Three  years  afterwards  the  patient  was  seen  again,  and  he  stated 
then  that  he  was  quite  well,  and  that  he  could  walk  without  diffi- 
culty or  fatigue;  but  a  year  later,  having  walked  a  distance  of 
many  leagues,  he  found  a  large  schar,  produced,  he  said,  by  the 
friction  of  his  pants  on  his  right  knee;  he  had  felt  no  pain,  and 
was  surprised  when  he  found  this  wound.  Although  sensibility 
was  still  deficient  in  this  limb,  all  its  movements  were  executed 


DECUSSATION    OF   SENSITIVE    FIBEES.  99 

freely,  and  without  fatigue.  (Vigues,  in  Moniteur  des  Hopitaux,  Sept. 
3,  1855,  p.  838.) 

This  important  case,  so  carefully  reported  by  my  friend,  M. 
Vigues,  has  not  the  sanction  of  a  post-mortem  examination,  but  it 
is  so  much  in  accordance  with  the  results  of  experiments  in  animals 
that  we  have  thought  there  could  be  no  objection  to  our  giving  it 
as  a  proof  of  the  exactitude  of  our  views.  There  are  several 
points  that  are  certain,  or  almost  certain:  in  the  first  place,  the 
sword  entered  the  cord  by  its  posterior  surface;  in  the  second 
place,  its  direction  was  oblique  from  behind  forwards,  and  from  the 
right  to  the  left.  These  two  facts  being  acknowledged,  if  we  re- 
member that  the  point  was  eight  millimetres  large,  and  that  it  pene- 
trated transversely — i.  e.,  its  edges  being  on  a  line  perpendicular  to 
the  longitudinal  axis  of  the  cord — we  are  enabled  to  judge  of  the 
injury  inflicted  to  the  cord.  Let  us  first  admit  the  old  theory,  that 
the  posterior  column  of  the  right  side  transmits  the  sensitive  im- 
pressions of  the  right  side  of  the  body,  and  that  the  left  anterior 
column  transmits  the  orders  of  the  will  to  the  muscles  of  the  left 
side  of  the  body.  Now  let  us  suppose  a  section  of  the  right  poste- 
rior column  and  the  left  anterior  column :  there  would  have  been 
then  just  what  occurred  in  this  case,  loss  of  movement  particularly 
in  the  left  limb,  and  loss  of  sensibility  in  the  right  limb  alone. 
But  I  will  remark  that  such  an  injury  was  impossible  with  such  a 
sword.  Had  the  left  anterior  column  been  entirely,  or  almost  en- 
tirely divided  at  the  same  time  with  the  right  posterior  column,  the 
left  posterior  column  would  also  necessarily  have  been  cut  across, 
the  sword  having  at  its  point  almost  the  same  diameter  as  the  whole 
spinal  cord ;  and  had  the  left  posterior  column  been  divided,  the 
left  limb,  according  to  the  theory  just  exposed,  would  have  lost  its 
sensibility,  and  would  not  have  been  hyperaesthetic  as  it  has  been. 
We  must  therefore  put  aside  the  supposition  which  we  have  made. 
Now,  if  we  take  any  of  the  theories  that  have  been  proposed  con- 
cerning the  transmission  of  the  orders  of  the  will  to  muscles,  or  of 
the  sensitive  impressions  to  the  brain,  through  the  spinal  cord,  we 
find  that,  except  ours,  they  are  all  unable  to  explain  the  facts  of 
this  case.  We  think  that  the  point  of  the  sword  entered  the  cord 
by  only  one  of  its  edges  (the  right  one),  dividing  entirely  the  left  pos- 
terior column,  and  a  part  of  the  right  one,  and  also  almost  the  whole 
of  the  gray  matter  and  of  the  lateral  column  on  the  left  side,  and 
a  part  of  the  anterior  column  of  the  same  side,  leaving  the  gray 
matter  and  the  antero-lateral  column  of  the  right  side  uninjured, 


100  THE    CENTRAL    NERVOUS    SYSTEM. 

except  by  the  pressure  upon  them  by  the  blood  which  must  have 
been  effused  on  the  withdrawal  of  the  sword.  In  this  way  we  can 
explain  the  rapid  return  of  voluntary  movements  in  the  right  limb, 
by  the  absorption  of  the  blood ;  and  we  explain,  1st,  the  loss  of 
sensibility  and  the  persistence  for  years  of  a  degree  of  anaesthesia 
in  the  right  limb,  by  the  section  of  almost  the  whole  of  the  gray 
matter  in  the  left  side;  2d,  the  hyperesthesia,  by  the  peculiar  in- 
fluence we  have  found  that  a  section  (complete  or  incomplete)  of  a 
lateral  half  of  the  cord  possesses  on  the  sensitive  nerves  originat- 
ing from  the  same  side  of  the  cord  below  the  injured  part;  3d,  the 
more  complete  diminution  of  movements  in  the  left  than  in  the 
right  limb,  by  the  injury  to  the  gray  matter  and  anterior  column 
of  that  side,  and  in  a  measure  also  to  the  left  column  of  the  same 
side. 

There  was  no  autopsy,  also,  in  the  two  following  cases. 

Case  33. — A  man  fell  on  his  back,  from  a  height  of  twenty  feet. 
After  having  recovered  his  consciousness,  he  discovered  that  the 
whole  left  side  of  his  body,  from  the  shoulder  down  to  the  foot, 
was  paralyzed  of  movement,  but  that  there  was  not  the  slightest 
diminution  of  sensibility,  and  that  the  right  side  of  the  body,  in 
which  the  movements  were  free,  was  completely  deprived  of  sensi- 
bility. 

Three  months  after  this  accident  the  patient  was  in  the  following 
state :  When  a  needle  or  a  lancet  was  introduced  in  the  right  limbs, 
the  muscles  of  which  obeyed  the  action  of  the  will,  there  was  no 
pain  felt.  The  reverse  existed  in  the  left  side,  where  sensibility 
was  morbidly  increased.  The  muscles  of  the  right  side  were  pro- 
minent, strong,  and  in  good  state  of  nutrition,  and  not  paralyzed ; 
while  those  on  the  left  side  were  emaciated,  and  incapable  of  any 
voluntary  movement.  The  temperature  of  the  right  side  was  one 
degree  and  a  half  lower  (Reaumur's  scale,  nearly  4°  Fahr.)  than 
that  of  the  left  side,  which  was  above  the  normal  temperature. 
Although  sensibility  was  entirely  abolished  in  the  right  side,  the 
patient  was  able  to  distinguish  with  the  right  hand  the  weight  of 
external  objects.  The  hand  and  the  foot  on  the  left  side  were  cede- 
matous.  Above  the  fourth  cervical  vertebra  sensibility  and  volun- 
tary movements  were  in  a  normal  condition.  (Dundas,  in  the 
Edin.  Med.  and  Surg.  Joum.,  April,  1825.) 

When  Dr.  Dundas  published  this  curious  case  (which  I  give  here 
from  a  translation  by  Ollivier,  loco  cit.,  vol.  i.  p.  509),  the  patient 


DECUSSATION    OF    SENSITIVE    FIBRES.  101 

was  living  and  improving,  so  that  we  do  not  know  what  was  the 
alteration  existing  in  the  spinal  cord,  but  the  analogy  between  this 
case  and  other  cases  in  which  the  autopsy  was  made,  and  with  the 
results  of  my  experiments  on  animals,  renders  it  almost  certain 
that  the  left  lateral  half  of  the  cord  had  been  altered.  In  the  fol- 
lowing case,  the  direction  of  tbe  wTound  renders  it  almost  certain 
that  the  same  symptoms  had  followed  a  division  of  the  lateral  half 
of  the  spinal  cord. 

Case  34. — A  drummer  of  the  National  Guard  of  Paris  received 
a  wound  in  the  back  of  the  neck.  A  sword  thrown  at  him  had 
penetrated  the  superior  part  of  the  lateral  half  of  the  neck.  An 
incomplete  paralysis  of  movement  took  place  in  the  right  side  of 
the  body,  and  some  time  after  it  was  accidentally  discovered  that  sen- 
sibility was  lost  in  many  parts  of  the  left  side  of  the  body.  After 
twenty  days  the  wound  was  cured,  and  the  man  went  out  of  the 
hospital,  but  still  paralyzed.  (Boyer,  in  Traite  des  Maladies  Chirur- 
gicales,  vol.  vii.  p.  9.) 

The  wound  in  the  neck  was  in  the  right  side;  the  paralysis  of 
movement  was  limited  to  the  right  side  of  the  body,  so  that  the  left 
side  of  the  cord  was  not  injured;  and,  from  what  is  taught  by  ex- 
periments on  animals,  it  seems  certain  that  nearly  all,  if  not  all,  the 
right  lateral  half  of  the  cord  had  been  divided  transversely. 

In  the  following  case  there  was  some  complication,  but,  never- 
theless, we  think  that  such  a  case  can  be  explained  only  by  the 
theories  we  have  proposed. 

Case  35. — A  woman,  aged  twenty-three,  after  recovering  from 
cholera,  felt  great  weakness  especially  of  the  lower  extremities. 
After  two  months,  the  motion  of  both  legs  was  found  greatly  im- 
paired, especially  of  the  left,  in  which  there  was  also  diminished 
sensation,  and  a  pain  which  extended  from  the  origin  of  the  sciatic 
nerve,  quite  to  the  extremity  of  the  toes ;  and  both  limbs  were 
affected  with  a  sense  of  coldness  and  prickling.  Soon  after  this 
she  began  to  have  pain  in  the  lumbar  region,  and  this  was  succeeded 
by  acute  pain  in  both  limbs,  with  convulsive  retraction  of  the  toes. 
This  pain  was  most  acute  in  the  left  limb,  and  there  was  now  in- 
creased sensibility  of  the  left  foot,  so  that  the  slightest  touch  produced 
a  sense  of  laceration,  and  this  morbid  sensibility  afterwards  extended 
to  the  knee.     The  right  limb  was  continually  numb,  but  some  degree 


102  THE    CENTKAL    NERVOUS    SYSTEM. 

of  motion  remained  in  both.  She  died,  after  gradual  exhaustion, 
six  or  seven  months  from  the  commencement  of  the  disease. 

Autopsy. — At  the  lower  extremity  of  the  spinal  cord  was  a  firm, 
white  tumor,  the  size  of  a  filbert,  inclosed  in  a  cyst,  and  slightly 
softened  in  the  centre.  It  lay  between  the  two  columns  of  the  left 
side,  and  in  some  degree  encroached  upon  those  of  the  right ;  the 
left  anterior  column  in  particular  was  much  distended  and  flattened 
by  it.  (Gendrin  in  Pathological  and  Practical  Researches  on  Diseases 
of  the  Brain,  &c,  by  J.  Abercrombie,  4th  edition,  1845,  p.  369.) 

It  would  be  difficult  to  find  a  case  presenting  more  interesting 
features  than  this  one.  Unfortunately,  however,  the  precise  place 
occupied  by  the  tumor  has  not  been  mentioned,  Mr.  Gendrin 
merely  stating  that  it  was  at  the  lower  extremity  of  the  cord.  The 
tumor,  as  shown  by  this  statement,  as  well  as  by  the  symptoms,  was 
not  above  the  place  of  decussation  of  the  conductors  of  sensitive 
impressions  from  the  lower  limbs,  and,  besides,  it  was  not  entirely 
in  one  lateral  half  of  the  spinal  cord.  These  two  reasons  explain 
that  there  was  a  diminution  of  sensibility  in  the  upper  part  of  the 
left  leg,  their  conductors  being  injured  while  crossing  the  cord  from 
the  left  to  the  right  side.  The  left  foot  and  also  the  left  leg,  up  to 
the  knee,  had  the  most  marked  hyperesthesia,  their  conductors 
having  made  their  decussation  below  the  tumor,  and  being  able 
therefore  to  transmit  sensitive  impressions  through  the  right  side 
of  the  cord,  which  transmission  they  performed  with  the  peculiar 
painful  character  which  exists  after  an  injury  to  either  the  anterior, 
the  lateral,  or  the  posterior  columns.  The  right  limb  was  continu- 
ally numb,  on  account  of  the  injury  to  many  of  its  conductors  of 
sensitive  impressions  in  the  gray  matter  and  in  the  anterior  co- 
lumns of  the  left  side  of  the  cord. 

This  case  is  not  only  instructive  in  showing  that  there  ought  to 
be  a  decussation  of  the  conductors  of  sensitive  impressions  in  the 
spinal  cord,  but  also  in  proving  that  the  posterior  columns  are  not 
the  place  through  which  these  conductors  go  up  to  the  brain,  as  we 
find  here  these  columns  uninjured,  and  sensibility  diminished  in 
many  parts. 

Some  of  the  cases,  already  mentioned  to  establish  the  exactitude 
of  my  views  concerning  the  decussation  of  the  conductors  of  sen- 
sitive impressions  in  the  spinal  cord,  are  far  from  being  positive 
proofs  of  these  views,  no  autopsy  having  shown  the  real  extent  of 
the  injury;  but  there  are  two  reasons  which  have  decided  my  re- 
lating them,  as  giving  a  strong  additional  evidence.     The  first  of 


DECUSSATION    OF    SENSITIVE    FIBRES.  103 

these  reasons  is,  that  the  symptoms  observed  in  these  pathological 
facts  (see  Cases  32,  33,  34,  and  35)  are  the  same  as  those  which  I 
have  shown  to  exist  in  animals  after  a  section  of  a  lateral  half  or 
some  other  injuries  to  the  spinal  cord,  so  that  it  seems  quite  certain 
that  the  same  injuries  existed  in  this  organ  in  these  cases.  The 
second  reason  is,  that  there  is  no  theory  able  to  explain  all  that  we 
know  of  these  cases,  except  that  the  theory  we  are  now  trying  to 
prove.  I  add  to  these  reasons  that  in  Cases  32  and  34  the  direc- 
tion of  the  sword  and  its  shape  and  size  were  such  that  the  injury 
must  have  been  what  we  have  already  stated.  It  seems,  therefore, 
that  of  the  seven  cases  (from  29  to  35)  which  we  have  related  to 
ground  our  theory,  there  are  three  (29,  30,  31)  which  are  as  direct 
and  as  positive  proofs  as  possible  of  the  exactitude  of  this  theory, 
and  there  are  four  (32  to  35)  which  have  an  indirect  but  a  great 
value  for  the  establishment  of  this  doctrine.  We  will  now  relate 
two  more  cases,  which,  although  they  do  not  give  a  positive  proof, 
are  very  interesting  by  the  symptoms  which  they  have  offered,  and 
because  they  afford  an  additional  testimony  of  inestimable  value 
in  support  of  the  view  that  the  conductors  of  sensitive  impressions 
decussate  in  the  spinal  cord. 

Case  36. — A  young  man  received  a  blow  of  a  quadrangular  and 
acute  poniard,  which  entered  the  neck  below  the  left  ear,  being 
directed  towards  the  beginning  of  the  spinal  cord.  Immediately 
all  the  parts  below  the  head  lost  sensibility  and  motion.  He  was 
brought  home  and  put  in  bed,  and  there,  amongst  other  things  that 
the  impediment  to  his  respiration  allowed  him  to  say,  he  com- 
plained of  being  cold,  and  without  any  feeling  he  was  burnt  on  the 
thighs,  the  legs,  and  feet,  in  consequence  of  the  application  of  a 
heated  metallic  vase  to  those  parts.  The  left  side  of  the  body 
began  for  the  first  time  to  recover  some  feeling  on  the  seventeenth 
day,  and  on  the  twentieth  he  began  to  move  the  toes  and  fingers 
of  the  same  side,  and  these  two  faculties  increased  gradually  until 
the  thirtieth  day  in  this  side.  Only  on  the  thirty-second  day  there 
was  a  return  of  some  feeling  in  the  right  side  of  the  body ;  move- 
ment also,  but  later,  returned  slowly  there.  On  the  fortieth  day 
there  was  sensibility  and  movement  everywhere,  but  not  enough  to 
allow  the  patient  to  stand  up,  and  still  less  to  walk.  The  recovery 
was  so  slow,  that  four  months  after  the  accident  he  was  hardly 
beginning  to  get  out  of  bed,  and  to  walk  as  a  child  learning  to 
walk ;  even  then  there  was  less  power  of  movement  and  feeling  in 


104  THE    CENTRAL   NERVOUS   SYSTEM. 

the  right  than  in  the  left  side.  (Morgagni,  De  Sedibus  et  Oausis  Mor- 
borum,  &c.     Nona  ed.,  Lutetise,  1822,  tomus  sextus,  pp.  515-517.) 

In  this  interesting  case,  we  find  that,  although  the  wound  must 
have  been  more  extensive  in  the  left  side  of  the  spinal  cord  than  in 
the  right,  the  return  of  sensibility  was  quicker  and  greater  in  the 
left  than  in  the  right  side  of  the  body.  It  would  not  have  been  so 
if  there  was  no  decussation  of  the  conductors  of  sensitive  impres- 
sions in  the  spinal  cord.  In  this  respect,  therefore,  this  case  is  a 
good  one  in  support  of  my  views;  but  how  to  explain  that  the 
power  of  voluntary  motion  returned  quicker  in  the  side  most 
injured  than  in  the  other?  It  would  be  easy  to  understand  all  the 
phenomena  observed  in  admitting  that  the  medulla  oblongata,  just 
above  the  crossing  of  the  pyramids,  was  the  part  injured;  but  death 
would  have  been  an  immediate,  or  almost  immediate,  result  of  such 
a  wound,  so  that  we  must  admit  that  the  spinal  cord  is  the  organ 
that  was  injured.  In  trying  experiments  on  animals  to  solve  this 
difficulty,  I  have  found  that  the  introduction  of  an  instrument  in 
the  spinal  cord,  obliquely  from  the  left  to  the  right,  and  a  little 
from  behind  forwards  and  from  below  upwards,  and  dividing  on 
the  left  side  almost  all  the  central  gray  matter,  the  posterior  part 
of  the  lateral  column,  and  a  part  of  the  posterior  column,  and,  on 
the  right  side,  a  part  of  the  central  gray  matter  and  the  parts  of 
the  right  lateral  column  just  at  the  place  where  they  approach  the 
median  line  to  make  their  crossing  just  below  the  medulla  oblon- 
gata, I  produced  a  more  considerable  loss  of  voluntary  motion  and 
sensibility  in  the  right  than  in  the  left  side.  So  that  a  greater 
injury  to  the  gray  matter  on  the  left  than  on  the  right  side,  and  a 
greater  injury  to  the  lateral  column  (particularly  to  its  decussating 
part)  on  the  right  than  on  the  left  side,  are  probably  the  causes  of 
a  greater  loss  of  voluntary  movement  and  sensibility  in  the  right 
than  in  the  left  side  in  the  case  recorded  by  Morgagni.  We  must 
add,  that  the  complete  loss  of  sensibility  and  motion  in  the  begin- 
ning, in  that  case,  depended  upon  the  existence  of  some  hemor- 
rhage, with  pressure  upon  the  whole  spinal  cord,  besides  the  section 
of  certain  parts  of  this  organ. 

The  following  case  is  less  complicated  than  the  preceding : — 

Case  37. — Mrs.  W ,  after  a   profuse   hemorrhage,  became 

paralytic.  Upon  one  side  of  the  body  there  was  a  loss  of  sensi- 
bility, without,  however,  any  corresponding  diminution  of  power 
in  the  muscles  of  volition.     The  breast,  too,  upon  that  side,  par- 


DECUSSATION    OF    SENSITIVE    FIBEES.  105 

took  of  the  insensibility,  although  the  secretion  of  milk  was  as 
copious  as  in  the  other.  Upon  the  opposite  side  of  the  body  there 
was  defective  power  of  motion,  without,  however,  any  diminution 
of  sensibility.  The  arm  was  incapable  of  supporting  the  child,  the 
hand  was  powerless  in  its  grasp,  and  the  leg  was  moved  with 
difficulty  and  with  the  ordinary  rotatory  movement  of  a  paralytic 
patient;  but  the  power  of  sensation  was  so  far  from  being  impaired 
that  she  constantly  complained  of  an  uncomfortable  sense  of  heat, 
a  painful  tingling,  and  more  than  usual  degree  of  tenderness  from 
pressure,  or  other  modes  of  slight  mechanical  violence. 

Autopsy. — No  positive  disorganization  of  the  brain  could  be  de- 
tected ;  the  ventricles,  however,  contained  more  serum  than  usual ; 
and  there  were  found  thickening  and  increased  vascularity  of  the 
membranes,  with  firm  adhesion,  in  some  parts;  in  others,  an  appa- 
rently gelatinous,  transparent,  and  colorless  deposit  interposed 
between  them.  Unfortunately,  the  spinal  cord  was  not  examined. 
(H.  Ley,  in  a  letter  to  Sir  C.  Bell,  in  The  Nervous  System  of  the 
Human  Body,  3d  ed.,  1844,  p.  245.) 

This  case  acquires  importance  from  the  fact  that  there  was  no 
alteration  in  the  brain  that  could  account  for  the  symptoms,  and 
from  the  similitude  between  the  symptoms  and  those  observed  in 
animals  after  a  section  of  a  lateral  half  of  the  spinal  cord. 

Setting  aside,  in  this  lecture,  what  relates  to  temperature,  we 
state  that  a  transversal  section  of  a  lateral  half  of  the  spinal  cord 
causes  a  loss  of  voluntary  movement  in  the  corresponding  side  of 
the  body,  and  a  loss  of  sensibility  in  the  opposite  side,  and  if,  now, 
we  look  at  the  cases  we  have  related  to  see  how  they  agree  with 
this  general  result,  we  find  the  following  points : — 

Side  of  conservation  of  sensi- 
bility, or  of  hyperesthesia. 
right 
left 
right 
left 

right         f 
left 

If  we  add  to  these  cases  those  in  which  we  have  no  other  reason 
but  the  analogy  of  symptoms  with  those  observed  in  animals,  such 
as  Cases  33  and  37,  we  have  two  more  instances  of  this  curious  but 
simple  morbid  manifestation — i.  e.,  loss  of  movement  in  one  side, 
loss  of  sensibility  in  the  other.  In  animals,  as  I  have  often  said 
and  shown,  the  paralyzed  parts  are  in  a  state  of  hyperesthesia ;  in 


Cases. 

Side  of  the 

Side  of  the 

Side  of  the 

injury. 

paralysis. 

anaesthesia. 

29 

right 

right 

left 

30 

left 

left 

right 

31 

right 

right 

left 

32 

left  (probably) 

left 

right 

34 

right  (ib.) 

right 

left 

35 

left  (chiefly) 

left  (chiefly) 

right 

106  THE    CENTRAL    NERVOUS    SYSTEM. 

the  cases  I  have  related,  hyperaBsthesia  has  been  noted  in  Cases  32, 
83,  35,  and  37.  It  was  so  great  that  the  least  touch  produced  pain 
in  Cases  32  and  35.  It  would  have  been  found  in  the  other  cases, 
had  the  physicians  who  attended  the  patients  looked  for  it. 

The  cases  of  loss  of  movement  in  one  side  of  the  body  with  loss 
of  sensibility  in  the  opposite  side,  are  not  so  rare  as  a  great  many 
of  my  hearers  probably  think.  That  very  learned  writer,  Dr. 
Copland,  says  that  the  paralytic  affection  in  epilepsy  occasionally 
consists  "  of  loss  of  sensation  in  one  limb  and  of  loss  of  movement 
in  another,  on  the  opposite  side."  {Diet,  of  Pract.  Medicine,  vol.  i., 
1844,  p.  795.)  There  is  a  case  of  this  kind  in  the  Ephemeridce, 
Natural  Curios,  Cent,  ii.,  obs.  196;  and  Dr.  J.  Cooke  {History  and 
Method  of  Cure  of  Palsy,  1821,  p.  19)  says  that  Ramazzini  speaks 
of  a  person  in  whom  one  leg  had  lost  its  feeling,  but  not  its  power 
of  motion,  and  the  other  its  motion,  but  not  its  feeling.  He  also 
mentions  Se*nac  as  having  related  a  case  in  which  the  most  acute 
sensation  (hyperesthesia)  was  experienced  in  one  arm,  which  had 
lost  the  power  of  motion ;  whilst  in  the  other  arm  sensation  was 
lost,  though  motion  remained  perfect.  Burserius,  he  adds,  quotes 
a  similar  case  from  Heister.  (I  have  vainly  looked  for  this  case  in 
Heister's  works.)  In  a  recently  published  work  {Des  Paralysies 
des  Memhres  Inferieurs,  2de  partie,  1857,  p.  116,  par  R.  Leroy 
d'Etiolles)  there  is  a  case  of  hysteric  paralysis,  with  loss  of  move- 
ment in  one  side,  and  loss  of  sensibility  in  the  other.  Lastly,  Dr. 
R.  Bright  has  recorded  a  case  of  this  kind,  of  which  we  will  speak 
by  and  by. 

I  shall  not  stop  now  to  show  that  these  cases,  or  at  least  most  of 
them,  are  cases  of  alteration  limited  to  a  lateral  half  of  the  spinal 
cord,  as  I  shall  have  to  treat  of  this  subject  again  in  a  future  lec- 
ture, in  examining  the  symptoms  of  alterations  of  various  parts  of 
the  cerebro-spinal  axis.  I  set  aside,  also,  for  the  present,  cases 
which  might  be  considered  as  in  opposition  to  the  theory  I  try  to 
prove  in  this  lecture,  and  I  pass  immediately  to  the  second  series 
of  cases  which  I  have  to  relate  in  favor  of  this  theory. 

Second  Series  of  Cases  proving  that  the  Conductors  of  Sensitive  Impres- 
sions make  their  Decussation  in  the  Spinal  Cord. 

I  begin  this  series  by  a  most  important  case,  indeed,  from  which 
many  physiological  and  practical  deductions  may  be  drawn.  It 
has  been  recorded  by  an  able  American  physician,  Dr.  Samuel 
Annan. 


DECUSSATION    OF    SENSITIVE    FIBEES.  107 

Case  38. — S.  G ,  aged  twenty-eight,  was,  on  the  14th  of 

May,  suddenly  seized  with  an  acute  pain  in  the  right  side  of  the 
head,  and  fell  down  in  a  state  of  insensibility,  remaining  so  for 
twenty-four  hours.  On  recovering,  she  found  she  had  lost  the 
power  of  moving  her  left  arm,  and,  in  a  great  degree,  that  of  mov- 
ing the  leg  of  the  same  side.  The  right  side  was  unaffected,  except 
the  face,  the  muscles  of  which  were  paralyzed ;  those  of  the  left  side 
of  the  face  retained  their  power.  Sensibility  of  the  left  side  of  the 
body  was  destroyed,  and  likewise  that  of  the  right  side  of  the  face. 
She  could  not  hear  with  the  right  ear.  The  right  eye  became 
inflamed  several  weeks  before  her  death,  and  the  cornea  was 
slightly  ulcerated;  the  upper  eyelid  was  constantly  raised.  Her 
muttering  was  scarcely  intelligible ;  paralysis  of  all  the  parts 
affected  became  complete;  deglutition  and  mastication  performed 
with  great  difficulty. 

Autopsy,  twelve  hours  after  death. — A  fibrous,  semi-cartilagiDOus 
tumor  was  found  on  the  right  side  of  the  tuber  annulare  and  the 
medulla  oblongata,  seated  in  the  substance  of  the  dura  mater  and 
other  membranes.  It  extended  from  the  point  where  the  fifth  pair 
of  nerves  arises  from  the  tuber  annulare,  covered  the  origin  of  this 
nerve  and  the  whole  of  the  right  side  of  the  tuber  below  this,  and 
passed  down  along  two-thirds  of  the  medulla  oblongata,  and  ad- 
hered to  the  right  side  of  the  basilar  artery.  The  right  vertebral 
artery  was  inclosed  in  the  tumor,  which  was  about  two  inches 
long.  The  surface  of  the  root  of  the  right  crus  cerebelli  on  which 
it  pressed  was  softened,  as  was  also  that  part  of  the  tuber  annulare 
on  which  it  lay.  It  was  incorporated  with  the  substance  of  the 
right  side  of  the  medulla  oblongata,  and  had  produced  softening  as 
far  as  it  reached.  This  softening  extended  through  the  posterior 
tract,  but  became  less  as  it  approached  the  posterior  surface.  The 
anterior  tract  was  a  pulpy  mass.  Neither  the  anterior  nor  the 
posterior  tract  of  the  left  side  was  perceptibly  affected.  The  tumor 
pressed  upon  the  roots  of  the  fifth,  seventh,  eighth,  and  ninth  pairs 
of  nerves.  (S.  Annan,  in  the  American  Journal  of  the  Medical  Sciences, 
vol.  ii.,  July,  1841,  p.  105.) 

The  author  justly  says:  "The  right  side  of  the  medulla  oblon- 
gata was  softened  to  the  extent  of  complete  disorganization;  there 
was  complete  paralysis  both  of  motion  and  sensation  on  the  left 
side.  The  decussation  of  the  fibres  of  the  corpora  pyramidalia 
explains  the  loss  of  motion  in  the  opposite  side,  but  as  we  have  no 
facts  proving  a  similar  interlacement  of  the  fibres  of  the  posterior 


^\ 


108  THE    CENTRAL    NERVOUS    SYSTEM. 

or  sensory  tract,  it  is  not  easy  to  discover  how  it  happened  that 
the  right  side  was  not  deprived  of  sensation.  Motion  and  sensa- 
tion were  unimpaired  in  the  extremities  of  the  side  diseased ;  they 
were  both  destroyed  in  the  same  parts  of  the  opposite  or  left  side. 
Are  we  not  justified  from  this  in  making  the  inference  that  there 
is  a  decussation  of  the  fibres  for  sensation  as  well  as  those  for  mo- 
tion ?"  Certainly  this  is  a  very  proper  inference ;  but  this  question 
remains :  Where  does  the  decussation  of  the  "fibres  for  sensation" 
take  place?  Is  it  in  the  lower  part  of  the  medulla  oblongata, 
where  exists  the  decussation  of  the  anterior  pyramids,  or  in  the 
spinal  cord?  Lately,  Messrs.  Yulpian  and  Philipeaux  (Comptus 
Rendus  de  la  Societe  de  Biohgie,  Mars,  1858)  have  shown  that  there 
are  in  the  anterior  pyramids  fibres  originating  from  the  posterior 
horns  of  gray  matter,  and  decussating  with  the  other  decussating 
fibres  of  these  pyramids ;  and  they  suggest  that  a  crossing  for  sen- 
sation probably  exists  there.  Admitting  that  they  are  right,  these 
conductors  of  sensitive  impressions  would  pass  into  the  anterior 
pyramids,  and  they  themselves  state  that  it  must  be  so.  "We  will 
show,  in  the  lecture  on  the  medulla  oblongata,  that  this  view  is  in 
opposition  to  positive  facts,  and  particularly  to  the  celebrated  case 
of  alteration  of  the  anterior  pyramids,  which  has  been  recorded  by 
our  friend,  Professor  Lebert. 

We  think  that  the  case  of  Dr.  Annan,  if  we  take  into  account 
the  extent  of  the  injury  in  the  medulla  oblongata,  bears  out  clearly 
that  most  if  not  all  of  the  conductors  of  sensitive  impressions  from 
the  trunk  and  limbs  make  their  decussation  in  the  spinal  cord. 
But  the  importance  of  this  case  is  not  limited  to  this  demonstration : 
it  shows  at  once  the  radical  difference  between  the  symptoms  of  an 
alteration  of  a.  lateral  half  of  the  medulla  oblongata  above  the 
crossing  of  the  pyramids,  and  an  alteration  of  a  lateral  half  of  the 
spinal  cord  either  in  the  cervical  or  in  another  region.  In  this  last 
case,  as  we  have  shown  a  moment  ago,  there  is  loss  of  movement 
in  one  side  and  loss  of  sensibility  in  the  opposite  side ;  while  in  a 
case  of  alteration  above  the  crossing  of  the  pyramids,  we  find  that 
the  loss  of  movement  and  of  sensibility  are  both  in  the  opposite 
side.  'This  case  is  also  excellent  to  show  that  the  functions  attri- 
buted to  the  restiform  body  as  a  conductor  of  sensitive  impressions, 
and  to  the  cerebellum  as  either  a  centre  of  perception  of  these  im- 
pressions, or  as  a  regulator  of  our  voluntary  movements,  or  as  a 
centre  for  the  guiding  sensation,  whether  by  a  reflex  action  or 
otherwise,  are  not  performed  by  these  parts,  as  the  communication 


DECUSSATION    OF    SENSITIVE    FIBRES.  109 

between  the  cerebellum  and  the  right  side  of  the  body  through  the 
right  side  of  the  medulla  oblongata  was  almost  impossible,  a  small 
part  only  of  the  right  restiform  body  remaining,  and  sensibility  and 
voluntary  movements  being  preserved  in  this  side. 

In  the  following  case,  which  is  related  by  Broussais,  we  find, 
with  less  detail,  several  of  the  features  of  the  preceding  one. 

Case  39. — An  officer,  recovered  for  some  time,  after  having  been 
attacked  with  stupor,  vomiting,  &c;  but,  five  months  afterwards, 
hemiplegia  gradually  appeared  in  the  right  side;  the  leg  could  sup- 
port him  a  little;  the  arm  lost  both  movement  and  feeling.  Soon 
after,  the  left  eye  lost  its  transparency  and  became  atrophied ;  the 
left  eyelids  were  paralyzed.  A  few  weeks  after,  walking  was  still 
more  difficult,  and  speech  more  impeded,  and  death  occurred  after 
coma. 

Autopsy. — The  left  hemisphere  was  softened;  cerebellum  normal. 
At  the  upper  part  of  the  medulla  oblongata,  in  the  interior  of  the 
left  pyramidal  body,  there  was  a  cancerous  tumor,  the  size  of  a 
chestnut,  in  continuity  with  the  surrounding  nervous  tissue.  (Brous- 
sais, in  Traite  des  Phlegmasies  Chroniques,  troisieme  ed.,  1822,  p.  420.) 

The  state  of  sensibility  of  the  right  lower  extremity  is  not 
mentioned,  but  we  find  that  there  was  loss  of  feeling  in  the  right 
upper  limb,  and  a  tumor  in  the  left  side  of  the  medulla  oblongata 
showing  that  the  decussation  of  the  conductors  of  sensitive  impres- 
sions must  have  taken  place  below  the  point  injured — i.  e.,  in  the 
spinal  cord  or  the  lower  part  of  the  medulla  oblongata.  Now,  as 
there  is  no  proof  that  there  is  such  a  decussation  in  this  part  of  this 
nervous  centre ;  and  as,  on  the  contrary,  there  are  facts  in  opposi- 
tion to  the  view  that  there  is  such  a  crossing,  we  must  admit  that 
it  exists  in  the  spinal  cord.  The  same  thing  may  be  concluded 
from  a  case  of  M.  Carre'  (Archives  de  Ifedecine,  p.  234,  vol.  v.,  1834), 
in  which  a  cancerous  tumor  in  the  left  half  of  the  pons  Varolii,  ex- 
tending several  lines  in  the  medulla  oblongata  and  the  crus  cerebri, 
had  produced  paralysis  of  movement  and  sensibility  on  the  right 
side  of  the  body,  the  left  side  remaining  in  the  normal  state. 
Nearly  the  same  thing  existed  in  a  case  of  Friedreich,  (Beitraege  zur 
Lehre  von  den  Geschwulsten  innerhnlb  der  Schaedelhohle,  1853,  p.  29.) 
The  following  case  leads  also  to  the  same  conclusions : — 

Case  40. — A  young  Pole,  after  a  nervous  fever,  became  paralyzed 
of  sensibility  and  movement  in  the  left  side  of  the  body,  and  in 
the  risrht  side  of  the  face. 


110  THE    CENTRAL    NERVOUS    SYSTEM. 

Autopsy. — The  right  side  of  the  pons  Varolii  is  twice  its  normal 
size ;  it  extends  forwards  and  backwards,  where  it  passes  under  the 
right  olive,  compressing  the  neighboring  parts.  The  enlargement 
was  due  to  a  very  large  clot  of  blood  in  the  right  half  of  the  pons. 
(M.  H.  Eomberg,  in  Lehrbuch  der  Nervenkrankheiten,  1851,  vol.  i., 
part  2,  pp.  198,  202,  and  third  edition,  1857,  third  part,  p.  923.) 

In  many  cases  of  alteration  of  a  lateral  half  of  the  pons  Varolii, 
the  medulla  oblongata  not  being  injured,  we  find,  also,  the  paralysis 
of  movement  and  sensibility  only  in  the  opposite  side  (excepting, 
however,  the  face,  which  is  paralyzed  on  the  same  side).  Such 
cases  are  recorded  by  Gendrin,1  Charcellay,2  Greuzard3  Friedreich 
(loco  cit,  p.  15),  Cruveilhier,4  Dr.  E.  Bright,5  Dr.  J.  W.  Ogle,6  &c. 
In  many  other  cases,  in  which  one-half  of  the  pons  was  more  altered 
than  the  other,  there  was  paralysis  and  anaesthesia  in  the  two  sides 
of  the  body,  but  at  a  greater  degree  in  the  side  opposite  to  the  half 
of  the  pons  most  injured.  Cases  of  this  kind  are  recorded  by  Cru- 
veilhier,  Dr.  K.  Bright,  Abercrombie  (loco  cit.,  p.  235),  Hermann 
Komberg7 — whom  we  must  not  take  for  the  great  neuro-pathologist, 
Moritz  Heinrich  Romberg — Grenet,8  Poisson,9  Tacheron,10  Dr.  T. 
Inman,11  etc. 

These  cases  assuredly  show  that  the  decussation  of  the  conduc- 
tors of  sensitive  impressions  does  not  take  place  in  the  pons  Varolii, 
and  that  it  has  taken  place  before  they  reach  this  organ ;  and  there- 
fore that  it  occurs  either  in  the  spinal  cord  or  the  medulla  oblongata, 
a  question  which  is  solved  by  the  facts  we  have  mentioned  relating 
to  these  organs.  But  there  is  another  consequence  to  be  drawn 
from  many  of  these  cases:  if  the  pons  Varolii  were  a  place  of  pas- 
sage of  only  a  part  of  the  conductors  of  sensitive  impressions,  most 
of  these  conductors  passing  into  the  cerebellum  from  the  posterior 
columns  of  the  spinal  cord  and  their  continuation,  the  restiform 
bodies,  we  certainly  should  see  but  a  diminution,  and  not  a  com- 

1  Hist.  Anatom.  des  Inflammations,  vol.  ii.  p.  155. 

2  In  Ollivier,  loco  cit.,  vol.  ii.  p.  315. 

3  Archives  de  Medecine,  1834,  vol.  v.  p.  458. 

4  Anatomie  Pathologique,  livre  21. 

5  Reports  of  Med.  Cases,  vol.  ii.  part  1. 

6  Edinburgh  Monthly  Journal  of  Medicine,  March,  1855. 

7  Qusedam  de  Ponte  Varolii,  1838,  p.  17. 

8  Gaz.  Hebd.  de  Medec,  No.  38,  Sept.  1856. 

9  Bulletins  de  la  Societe  Anatom.,  Mai  et  Juin,  1855. 

,0  Rech.  Anat.  Pathol,  sur  la  Medecine  Pratique,  1823,  vol.  iii.  p.  450. 
11  Edinburgh  Medical  and  Surgical  Journal,  vol.  64,  1845,  p.  294. 


DECUSSATION    OF    SENSITIVE    FIBRES.  Ill 

plete  loss,  of  sensibility  in  those  cases  in  which  an  alteration  is 
limited  to  the  central  parts  of  the  pons  Varolii,  and  not  interfering 
with  the  cerebellum  and  its  peduncles.  It  is  usually,  however,  a 
complete  loss  of  sensibility  which  is  observed,  and  not  a  diminution. 
The  case  of  Greuzard;  already  mentioned,  is  particularly  interest- 
ing in  this  respect;  there  was  a  softening,  irregular  in  its  shape, 
large,  like  an  almond,  and  rose-colored,  in  the  inferior  and  middle 
part  of  the  right  half  of  the  pons  Varolii,  and  the  anaesthesia  and 
paralysis  of  the  left  side  of  the  body  had  been  complete.  In  a 
case  still  more  interesting,  and  which  I  shall  have  to  relate  by  and 
by  for  another  object,  there  was  a  tumor  in  the  left  half  of  the  pons 
Varolii,  with  complete  loss  of  sensibility  in  the  right  side  of  the 
body.  (Stuart  Cooper,  in  Bulletins  de  la  Soc.  Anat.,  1846,  p.  68.) 

In  our  Lecture  on  the  Functions  of  the  Medulla  Oblongata  and 
Pons  Varolii,  we  shall  have  to  treat  at  length  of  the  place  of  decus- 
sation of  the  conductors  of  the  orders  of  the  will  to  muscles ;  but 
we  must  now  point  out  the  following  characteristic  features  of 
alterations  limited  to  one  lateral  half  of  those  parts :  1st,  the  spinal 
cord  ;  2d,  the  medulla  oblongata,  at  the  place  of  the  crossing  of  the 
pyramids;  3d,  the  encephalon,  above  this  crossing. 

In  Fig.  21  may  be  seen  what  we  think  to  be  proved  by  patho- 
logical cases  in  this  respect :  1st.  In  the  spinal  cord  an  alteration 
in  a  lateral  half  produces  hyperesthesia  and  paralysis  of  movement 
in  the  corresponding  side,  behind  the  place  of  the  alteration,  and 
the  loss  of  sensibility,  without  loss  of  movement,  in  the  opposite 
side.  (See  3,  Fig.  21.)  2d.  In  the  lower  part  of  the  medulla  oblon- 
gata, diminution  of  movement  in  the  two  sides  of  the  body,  hyper- 
esthesia on  the  side  altered,  anesthesia  in  the  opposite  side.  (See 
2,  Fig.  21.)  3d.  Above  the  crossing  of  the  pyramids,  loss  of  move- 
ment and  sensibility  in  the  opposite  side,  and  hyperesthesia  with 
conservation  of  movement  in  the  side  of  the  alteration.  (See  1, 
Fig.  21.) 


112 


LECTURE    VIII 


CONCLUSIONS  FROM  THE  PATHOLOGICAL  CASES  RELATED  IN  THE  PRE- 
CEDING  LECTURES  AND  FROM  SEVERAL  OTHER  CASES,  AS  REGARDS 
THE  DIAGNOSIS  OF  ALTERATIONS  OF  THE  VARIOUS  PARTS  OF  THE 
SPINAL  CORD. 

Principal  symptoms  of  the  diseases  of  the  spinal  cord. — On  a  curious  symptom 
which  seems  to  "belong  especially  to  diseases  of  this  organ. — Cases  against  the 
views  of  Bellingeri  and  Valentin,  relative  to  the  pretended  motor  functions  of 
the  posterior  columns,  and  to  certain  symptoms  of  alterations  of  the  anterior 
columns. — Differences  in  the  degree  of  paralysis  of  voluntary  movements, 
according  to  the  extent  of  the  alteration  of  the  posterior  columns. — Absence 
of  paralysis,  in  cases  in  which  these  columns  are  entirely  cut  across,  but  not 
injured,  in  a  great  part  of  their  length. — Causes  and  nature  of  the  apparent 
paralysis  observed  when  a  great  part  of  the  length  of  the  posterior  columns  is 
altered. — Alteration  of  the  upper  part  of  the  anterior  columns  without  para- 
lysis.— Decussation  of  the  lateral  columns ;  their  function  and  symptoms  of 
their  alteration. — Paralysis  due  to  disease  of  the  gray  matter. — Alterations 
causing  a  loss  of  feeling  a  contact,  a  tickling,  a  muscular  contraction,  a  painful 
impression,  or  a  change  of  temperature. — Conclusions  concerning  anaesthesia. — 
When  does  anaesthesia  exist  without  a  notable  paralysis. — Rarity  of  complete 
anaesthesia. — Referring  of  the  various  kinds  of  sensitive  impressions  to  different 
parts  of  the  body  in  cases  of  alteration  of  the  spinal  cord. — Absence  of  excita- 
bility of  most  of  the  conductors  of  the  various  kinds  of  sensitive  impressions 
in  the  nerves  and  in  the  spinal  cord. — Inflammation  may  render  all  these  con- 
ductors excitable,  and  induce  the  production  of  all  kinds  of  sensations,  errone- 
ously referred  to  the  periphery. — Groups  of  symptoms  which  characterize 
alterations  limited  to  certain  parts  of  the  various  columns  of  the  spinal  cord 
and  of  its  gray  matter. 

Mr.  President  and  Gentlemen  :  Many  conclusions  having  a 
practical  bearing  may  be  drawn  from  the  facts  concerning  the 
spinal  cord  which  I  have  mentioned  in  several  of  the  preceding 
lectures.  I  will  now  point  out  those  conclusions,  and  relate  some 
new  facts  which  bear  them  out  as  well  as  those  I  have  already 
detailed.  I  will  at  first  examine  the  signification  of  the  various 
symptoms  of  disease  of  the  spinal  cord,  and  try  to  show  how  these 
symptoms  may  guide  in  the  diagnosis  of  the  place  injured;  then  I 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  113 

will  show  how  alterations  in  the  principal  parts  of  the  spinal  cord 
give  different  and  characteristic  symptoms. 

The  symptoms  of  injuries  or  alterations  of  the  spinal  cord  con- 
sist in  various  degrees  and  forms  of  paralysis  of  voluntary  move- 
ment ;  in  a  diminution  or  loss  of  the  various  kinds  of  sensibility, 
as  regards  contact,  temperature,  tickling,  muscular  sense,  pain;  in 
involuntary  movements — spasmodic,  choreic,  epileptiform,  &c;  in 
a  morbid  increase  of  the  various  kinds  of  sensibility ;  in  a  perver- 
sion of  sensations;  in  errors  as  to  the  place  of  starting  of  a  sensi- 
tive impression;  in  the  referring  of  sensitive  impressions  to  the 
extremities  of  the  conductors  of  these  impressions ;  in  the  absence, 
diminution,  or  increase  of  the  reflex  faculty,  &c. 

Paralysis  of  voluntary  movement  may  occur  in  consequence  of 
alterations  existing  almost  anywhere  in  the  spinal  cord.  This  may 
seem  to  be  very  strange,  particularly  when  we  remember  that  a 
transversal  section  of  the  posterior  columns  of  the  spinal  cord,  in 
animals,  is  without  influence  upon  voluntary  movements.  What 
are  the  deductions  to  be  drawn  from  pathological  cases  observed 
in  man  as  regards  the  share  of  the  posterior  columns  of  the  spinal 
marrow  in  voluntary  movements  ?  Three  questions  must  be  ex- 
amined in  this  respect :  First,  are  there  nerve-fibres  going  to 
muscles,  and  employed  in  voluntary  movements,  passing  along  the 
posterior  columns,  from  the  encephalon  down  to  the  spinal  nerves? 
Are  there  volitional-motor  nerve-fibres  passing,  for  a  short  distance, 
through  the  posterior  columns  ?  Are  there  some  peculiar  causes 
of  diminution  of  voluntary  movements  in  cases  of  alterations  of 
the  posterior  columns  ? 

The  first  of  these  questions  is  very  interesting,  both  in  a  physio- 
logical and  in  a  practical  point  of  view.  To  solve  it,  it  may  per- 
haps be  sufficient  to  remind  our  hearers  of  three  cases  (see  Lecture 
V.,  Cases  6,  7,  and  8),  which  we  have  already  related,  and  in  which 
voluntary  movements  persisted,  or  returned  after  a  time,  although 
the  posterior  columns  had  been  destroyed  in  a  small  part  of  their 
length,  just  as  if  they  had  been  divided  transversely.  Of  course, 
if  there  were  a  number  of  volitional  nerve-fibres  passing  along 
these  columns  of  the  cord  to  go  to  the  muscles  of  the  limbs,  there 
would  have  been  a  manifest  diminution  of  voluntary  movements 
in  these  cases ;  and,  as  this  did  not  take  place,  we  may  conclude — 
first,  that  the  posterior  columns  are  not  a  channel  between  the  will 
and  muscles;  and,  secondly,  that  a  paralysis  of  voluntary  move- 

H 


114  THE    CENTRAL    NERVOUS    SYSTEM. 

merits  is  not  a  symptom  belonging  to  a  section  or  a  local  destruc- 
tion of  the  posterior  columns  by  a  tumor,  or  a  piece  of  bone,  &c. 

According  to  the  views  of  Bellingeri,1  ably  supported  by  the 
learned  Prof.  Valentin,2  the  posterior  columns  of  the  spinal  cord 
contain  the  voluntary  motor  fibres  going  to  the  extensor  muscles. 
I  have  already  mentioned  and  shown  experiments  which  are  in 
opposition  to  this  hypothesis.  (See  Lecture  IY.)  I  will  now  show 
that  clinical  facts  also  disagree  with  it. 

There  is  a  very  curious  symptom  which  seems  to  belong  exclu- 
sively to  diseases  of  the  spinal  cord  (at  least  we  do  not  know  of 
any  case  of  disease  of  the  encephalon  in  which  this  symptom  has 
existed,  the  spinal  cord  being  healthy).  It  consists  in  a  spasm  of 
the  flexor  muscles  of  the  lower  limbs,  spasm  which  is  so  powerful 
that  the  anterior  parts  of  the  thighs  come  almost  in  contact  with 
the  abdomen,  while  the  heels  are  drawn  up  so  as  to  touch  the  back 
parts  of  the  thighs. 

Were  it  true,  as  admitted  by  Bellingeri  and  Valentin,  that  the 
anterior  columns  of  the  spinal  cord  are  a  bundle  of  nerve-fibres 
animating  the  flexor  muscles,  and  that  the  posterior  columns  con- 
tain the  nerve-fibres  animating  the  extensor  muscles ;  and  were  it 
true  also,  as  admitted  by  almost  all  physiologists,  that  the  nerve- 
fibres  have  the  same  excitability  in  the  spinal  cord  as  in  the  trunks 
and  branches  of  nerves,  we  should  see  flexion  produced  in  cases  of 
tumors  or  diseases  exciting  the  anterior  columns,  and  extension  in 
cases  of  excitation  of  the  posterior  columns.  Now,  in  examining 
pathological  cases  in  this  respect,  we  find  that  there  are  a  great 
many  more  in  which  neither  of  these  symptoms  have  existed  than 
cases  in  which  they  have  been  observed  with  the  peculiar  altera- 
tion which  should  be  connected  with  them. 

"We  can  say  more:  there  are  cases  in  which  an  irritation,  or  at 
least  an  alteration,  of  the  posterior  columns  has  produced  flexion. 
For  instance,  in  a  case  we  have  already  related  (Case  10,  Lecture 
V.),  the  knees  were  drawn  up  towards  the  abdomen,  the  legs  were 
bent  upon  the  thighs,  so  that  the  heels  rested  firmly  upon  the  soft 
parts  covering  the  tuber  ischii,  and  the  posterior  columns  in  the 
cervical  region  were  semi-fluid.  In  another  case,  that  of  a  young 
patient  whom  I  have  observed  at  the  Charitd  Hospital,  in  Paris 
(see  Case  9,  Lecture  V.),  there  was  also  a  flexion  of  the  lower  limbs, 

1  De  Medulla  Spinalis  Nervisque  ex  ea  Prodeuntibus,  &c.     Torino,  1823. 

2  De  Functionibus  Nervorum  Cerebralium,  &c,  p.  135.     1839. 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  115 

and  the  anterior  columns  were  healthy,  while  the  posterior  columns 
were  softened  in  the  cervical  region.  In  a  case  recorded  by  Mr. 
Colin,1  the  knees  were  drawn  up  towards  the  chest,  and  the  heels 
were  in  contact  with  the  back  parts  of  the  thighs,  pressing  against 
them ;  there  was  a  tumor,  two  inches  long,  pressing  against  the 
posterior  surface  of  the  spinal  cord  at  the  level  of  the  tenth  dorsal 
vertebra.  In  another  case  of  tumor  pressing  upon  the  posterior 
columns,  in  the  cervical  region,  the  same  thing  existed.  (See  Case 
12,  Lecture  Y.)  Besides,  there  are  several  other  cases  in  which 
the  alteration  was  certainly  not  a  simple  irritation  of  the  anterior 
columns,  and  in  which  the  symptom  we  study  (flexion  of  the  lower 
limbs)  has  existed.  So  it  was  in  a  very  interesting  case  recorded 
by  Mr.  Pilcher,2  in  which  tubercles  were  found  in  the  cerebral 
meninges  and  in  the  theca  vertebralis,  some  attached  to  the  roots 
of  the  spinal  nerves.  So  it  was,  also,  in  two  cases  mentioned  by 
Ollivier  (loco  cit.,  vol.  ii.  p.  444  and  p.  388),  in  one  of  which  there 
was  an  atrophy  of  the  lumbar  swelling  of  the  cord,  while  in  the 
other  there  was  a  destruction  of  the  gray  matter  in  the  cervical 
region  of  the  cord.  It  is  true,  however,  that  there  are  several 
cases  of  alteration  of  the  anterior  columns,  in  which  this  symptom 
has  existed.  Valentin  quotes  cases  of  this  kind  observed  by  Mar- 
shall Hall,  Cruveilhier,  Herbert  Mayo  (Outlines  of  Physiology,  p. 
156),  and  Ollivier. 

From  these  facts  it  results  that  the  spasmodic  flexion  of  the 
thighs  and  legs  is  a  symptom  which  does  not  belong  exclusively  to 
alterations  of  either  the  anterior  or  the  posterior  columns  of  the 
spinal  cord,  and  that  it  is  impossible  to  find  a  proof  of  the  exacti- 
tude of  the  views  of  Bellingeri  and  Valentin  in  establishing  a  con- 
nection betwreen  this  sympton  and  certain  parts  of  the  cord.  And 
we  may  be  permitted  to  add  that  alterations  of  the  posterior 
columns,  when  they  cause  paralysis  without  contraction,  do  not 
cause  simply  a  paralysis  of  the  extensor  muscles,  but  at  the  same 
time  a  paralysis  of  the  extensor  and  the  flexor  muscles :  and  that, 
on  the  other  hand,  when  there  is  paralysis  due  to  an  alteration  of 
the  anterior  columns,  it  exists  also  in  the  flexor  and  in  the  extensor 
muscles.  Besides,  in  cases  of  tetanus,  in  which  almost  always  the 
extensor  muscles  are  those  which  are  chiefly  convulsed,  the  parts 
of  the  cord  which  are  most  frequently  found  altered  are  precisely 
the  anterior  columns. 

1  Revue  Medicale,  Avril,  1824. 

2  The  Lancet,  April  1, 1848,  p.  368. 


116  THE    CENTRAL    NERVOUS    SYSTEM. 

Several  of  the  above  mentioned  facts  seem  to  be  decisive  against 
the  view  that  the  posterior  columns  contain  voluntary  motor  fibres 
descending  through  them  to  pass  into  motor  nerves.  But  there 
are  other  facts  which  seem  to  prove  what  is  disproved  by  the  preced- 
ing. For  instance,  in  several  cases  which  we  have  related  in  ano- 
ther lecture  (see  Lecture  V.,  Cases  10,  13,  14,  16),  although  sensi- 
bility persisted,  there  was  almost  a  complete  paralysis,  with  an 
alteration  of  the  posterior  columns.  The  details  of  these  cases 
show  that  they  differed  from  the  others  (Lecture  V.,  Cases  6,  7,  8), 
which  have  been  mentioned  a  moment  ago,  as  to  the  extent  of  the 
injury.  In  all  the  last  cases  there  was  a  considerable  alteration 
occupying  the  whole  length  of  the  posterior  columns,  either  in  the 
cervical  region  alone  (as  in  Case  10),  or  in  both  the  cervical  and 
dorso-lumbar  regions. 

In  reviewing  carefully  all  the  cases  that  we  know  of  alteration 
of  the  posterior  columns  of  the  spinal  cord,  we  find  that  usually  an 
alteration,  limited  to  a  small  part  of  the  length  of  these  columns, 
does  not  affect  the  voluntary  movements,  while,  on  the  contrary, 
there  is  no  case  in  which  an  alteration  extending  a  few  inches  in 
either  the  cervical  or  the  dorso-lumbar  regions,  has  not  produced  a 
diminution  of  voluntary  movements  in  either  the  upper  or  the 
lower  limbs.  When  the  alteration  exists  along  the  cervico-brachial 
enlargement,  the  paralysis  exists  in  the  upper  limbs  and  not  in  the 
lower  ones.  (See  Case  17,  Lecture  Y.)  There  are  several  cases, 
however,  in  which  an  alteration  in  the  cervical  region  co-existed 
with  a  paralysis  of  the  lower  limbs,  but  the  cause  of  this  loss  of 
power  may  be  found  in  other  circumstances  than  the  alteration  of 
the  posterior  columns,  as  we  shall  show  in  a  moment. 

Certainly  one  of  the  most  embarrassing  features  of  the  diseases 
of  the  spinal  cord  consists  in  a  complete  paralysis  in  cases  where 
the  posterior  columns  alone  are  said  to  be  affected.  The  celebrated 
case,  reported  by  Mr.  Edward  Stanley,  is  one  of  this  kind.  (Case 
14,  Lecture  Y.)  The  following  clinical  fact  is  extremely  interesting 
in  this  respect,  and  also  as  regards  the  conservation  of  sensibility. 

Case  41. — E.  B ,  aged  seventeen,  was   admitted  into  the 

Pennsylvania  Hospital,  with  complete  paralysis  of  all  the  limbs, 
which  had  followed  an  attack  of  typhoid  fever.  From  first  to  last 
his  intellect  was  perfectly  clear :  he  had  no  pain  in  his  head ;  his 
senses  were  perfect ;  his  countenance  natural,  and  he  had  no  spasms 
or  convulsions.     During  a  part  of  the  time  his  bladder  and  rectum 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  117 

were  involved  in  the  paralysis.  Although  the  loss  of  power  was 
complete,  or  nearly  so,  the  sensation  in  the  limbs  was  preserved. 
Some  time  after  his  admission,  the  limbs,  especially  the  upper  ones, 
became  the  seat  of  permanent  contractions,  the  forearm  being 
flexed  upon  the  arm,  the  hand  upon  the  forearm,  and  the  fingers 
upon  the  hand.  For  some  time  previous  to  his  death,  the  power 
of  the  bladder  and  rectum  was  restored,  and  there  was  a  slight 
return  of  motion  in  the  limbs.  The  patient  died  of  pulmonary 
consumption. 

Autopsy  fourteen  hours  after  death. — Substance  of  the  brain  per- 
fectly healthy.  Vault  and  septum  lucidum  softened,  as  well  as 
the  surface  of  the  thalami  and  of  the  corpora  striata,  forming  the 
walls  of  the  ventricles.  Some  effusion  in  the  ventricles;  some 
adhesions  between  the  opposing  surfaces  of  the  arachnoid  and 
between  the  pia  mater  and  the  cord.  Upon  dividing  the  posterior 
fissure,  the  substance  of  the  spinal  marrow  was  found  perfectly 
pulpy,  and  of  a  milk-white  color.  This  softening  extended  through- 
out the  whole  length  of  the  column,  but  was  most  marked  inferiorly, 
less  so  in  the  cervical,  and  least  of  all  in  the  dorsal  portion.  It 
was  limited  to  the  posterior  columns,  which  were  softened  through- 
out, its  limits  being  distinctly  marked  by  the  posterior  horns  of 
the  gray  matter,  which  was  rather  paler  and  less  distinct  than 
natural.  The  anterior  columns  were  of  natural  consistence  and 
color.     (The  Medical  Examiner,  vol.  i.  p.  273.     Philadelphia,  1838.) 

This  curious  case  is  certainly  a  good  additional  proof  against  the 
view  that  the  posterior  columns  of  the  cord  are  the  only  channels 
for  sensitive  impressions.  Its  signification  concerning  voluntary 
movements,  we  will  discuss  presently. 

To  make  out  the  diagnostic  value  of  paralysis,  in  cases  of  altera- 
tion of  the  posterior  columns,  it  will  prove  useful  to  examine  what 
degree  and  what  kind  of  paralysis  existed  in  connection  with 
alterations  in  the  spinal  cord.  We  shall  see  that  in  most  of  the 
cases  of  alterations  of,  or  injuries  to,  the  posterior  columns  that  we 
have  related  in  the  preceding  lectures,  there  was  some  other  part 
of  the  cerebro-spinal  axis  altered,  and  that  in  the  few  cases  in 
which  the  posterior  columns  were  alone  altered,  the  paralysis  of 
voluntary  movements  was  not  complete. 


118 


THE    CENTRAL    NEKVOUS    SYSTEM. 


Cases.  Altered  Parts. 

1.  Posterior  columns,  posterior  roots,  gray  matter. 

9  u  <<  u  u  u  a 

3  (l  U  M  (i  u  << 

4.  The   whole    cord    (atrophy),   median    posterior 

columns    (induration),    and    posterior   roots 
(atrophy). 

5.  Posterior  columns,  and  most  probably  the  pos- 

terior roots. 

6.  Posterior  columns  (tumor,  cervical  region). 

7.  Posterior  surface    (bayonet   wound  below  last 

dorsal  vertebra). 

8.  Posterior  columns  (probably  divided  with  some 

parts  around). 

9.  Posterior  columns,  also  various  other  parts. 

10.  Back  part  (semi-fluid),  the  rest  softened  in  cer- 

vical region. 

11.  One  of  the  posterior  columns  (in  medulla  oblon- 

gata) and  neighboring  parts  (pressure  by  a 
tumor). 

12.  Posterior  columns  (chiefly  the  left),  rest  of  the 

cord  reduced  to  two-thirds  of  its  size  (tumor, 
level  of  second  dorsal  vertebra). 

13.  Posterior  columns,  in  all  their  length  and  thick- 

ness. 

14.  Posterior  columns,  from  the  pons  to  the  other 

end. 

15.  Posterior  columns    (about   two   inches,  level  of 

fifth  dorsal  vertebra). 

16.  Posterior  columns,  and  also,  though  less,  the  rest 

of  the  cord  (cervical  region). 

17.  Posterior  columns    (cervico-brachial   swelling), 

posterior  roots  also. 

18.  Posterior  columns  (lumbar  swelling). 

19.  Posterior  columns,  and  some  parts  of  the  brain. 
41.  Posterior  columns  (the  whole  length). 


Degree  of  Paralysis. 
Probably  complete. 
Incomplete. 
Incomplete. 
Probably  complete. 


Incomplete. 

No  paralysis. 
No  paralysis. 

At  first  paralysis,  but  after- 
wards entire  return  of 
voluntary  movements. 

Complete. 

Almost  complete. 

Not  very  marked. 
Probably  complete. 

Incomplete. 

Complete  (but  only  in  lower 

limbs). 
Probably  complete. 

Complete. 

Complete  in  upper  limbs  (?) 

Incomplete. 
Completed) 
Almost  complete. 


We  find  the  paralysis  complete,  or  probably  complete,  in  Cases 
1,  4,  9,  12,  14,  15,  16,  17,  and  19.  But  Case  1  cannot  prove  any- 
thing, because  the  gray  matter  was*  altered ;  Case  4,  because  the 
whole  cord  was  atrophied;  Case  9,  because  various  alterations 
existed  in  the  brain,  and  the  state  of  the  limbs,  which  were  in  a 
permanent  spasmodic  flexion  probably  due  to  an  old  spinal  menin- 
gitis, prevented  the  action  of  the  will;  Case  12,  because  the  rest  of 
the  cord  was  also  altered,  the  organ  being  reduced  to  two-thirds  of 
its  volume ;  Case  14,  because  the  alteration  does  not  answer  to  the 


CONCLUSIONS    FROM   PATHOLOGICAL    CASES.  119 

symptoms  observed  (no  paralysis  at  all  in  the  upper  limbs  and  com- 
plete paralysis  in  the  lower  ones,  with  an  alteration  of  the  whole 
length  of  the  posterior  columns);  Case  16,  because  the  rest  of  the 
cord  was  also  altered ;  Case  19,  because  some  parts  of  the  brain 
were  altered. 

Two  cases,  15  and  17,  are  the  only  ones  about  which  we  may 
have  doubts.  However,  in  Case  15  there  was  a  curvature  of  the 
spine,  and  most  probably  the  curved  part  of  the  anterior  half  of 
the  cord  had  some  alteration  which  was  not  sufficiently  evident  to 
be  detected  with  the  naked  eye.  This  is,  at  any  rate,  the  only  case 
that  I  know  of  an  alteration  said  to  be  limited  to  the  posterior 
columns,  with  a  complete  loss  of  voluntary  movements ;  and  this 
case,  which  would  be  quite  insufficient  to  prove  that  these  columns 
are  the  channels  of  the  orders  of  the  will  to  muscles,  is  entirely  in 
opposition  to  many  other  cases  (see  Cases  6,  7,  8,  11,  &c),  which 
establish  the  reverse.1  As  regards  Case  17,  there  has  certainly 
been  some  mistake  made  by  the  author  who  reported  it,  as  he 
states  that  the  posterior  roots  were  in  a  state  of  putrilage  and  that 
sensibility  was  preserved. 

In  two  of  the  cases  of  the  above  list  there  was  almost  a  complete 
paralysis  (Cases  10  and  41).  In  one  of  these  there  was  softening 
in  the  whole  thickness  of  the  cord,  though  less  than  in  the  poste- 
rior columns  (Case  10).  The  state  of  voluntary  movements  had 
partly  its  cause  in  this  condition  of  the  cord,  but  there  was  also 
another  cause  of  paralysis — the  spasmodic  flexion  of  the  limbs.  As 
regards  Case  41,  although  there  was  a  softening  of  the  walls  of  the 
lateral  ventricles,  we  think  the  principal  cause  of  the  paralysis  was 
in  the  spinal  cord.  If  we  remark  that  there  was  no  hyperassthesia 
(as  we  know  that  hyperesthesia  alwa}^s  exists  in  diseases  of  the 
posterior  columns,  unless  there  is  a  cause  of  diminution  of  sensi- 
bility, which  reduces  hyperesthesia  so  much  that  the  degree  of 
sensibility  seems  to  be  normal),  and  if  we  remark  also  that  the  gray 
matter  is  said  to  have  been  paler  and  less  distinct  than  natural, 
we  have  sufficient  explanation  of  the  paralysis,  without  admitting 
that  the  whole  of  it  was  due  to  the  alteration  of  the  posterior 
columns. 

Now  we  must  point  out  a  capital  distinction  which  relates  to  the 
extent  (in  length)  of  the  alteration  in  the  posterior  columns.  If  the 
alteration  is  very  little  extended,  it  allows  reflex  actions  to  take 

1  For  other  remarks  on  this  interesting  case,  I  will  refer  to  Lecture  V. 


120  THE    CENTRAL    NERVOUS    SYSTEM. 

place ;  but  if,  for  instance,  it  extends  to  the  whole  of  the  lumbar 
swelling,  it  prevents  these  actions,  and  as  walking,  standing,  &c, 
cannot  be  perfected  without  them,  it  follows  that  there  is  a  degree 
of  apparent  paralysis  of  voluntary  movements.  If  the  alteration 
extends  to  the  whole  length  of  the  posterior  columns,  the  loss  of 
reflex  action  in  the  muscles  of  the  limbs  renders  their  voluntary 
movements  much  less  powerful.  It  is  not  so  in  cases  in  which  the 
alteration  of  the  posterior  columns  occupies  only  a  small  part  of 
their  length  (as  in  Cases  6,  7,  8  and  11);  reflex  action  persisting, 
voluntary  movements  are  hardly  diminished. 

It  might  be  supposed  that  there  are  some  of  the  voluntary  motor 
conductors  that  pass  into  the  posterior  columns  for  a  short  distance, 
so  that  an  alteration  existing  in  the  whole  length  of  these  columns 
destroys  all  these  conductors,  while  a  local  alteration  destroys  but 
very  few  of  them.  It  may  be  so,  but  we  do  not  see  any  proof  of 
it,  either  in  experiments  or  in  pathological  cases. 

It  remains  now  to  examine  what  kind  of  alteration  in  voluntary 
movements  there  is  in  cases  of  alteration  of  the  posterior  columns. 
When  the  posterior  roots  are  also  altered,  there  is  an  absence  of 
the  power  of  guiding  the  movements  which  renders  walking  almost 
completely  impossible  (see  Cases  2  and  8).  When  in  bed,  the 
patients,  looking  at  their  limbs,  can  make  any  movements ;  but 
they  cannot  walk,  or  stand  on  their  feet,  and  when  their  eyes  are 
shut  they  can  hardly  make  the  least  movement. 

From  the  facts  we  have  just  discussed,  and  from  the  reasonings 
we  have  exposed,  it  results — 

1st.  That  a  complete  loss  of  voluntary  movements  is  not  a  symp- 
tom depending  upon  an  alteration  limited  to  the  posterior  columns, 

2d.  That  in  cases  of  alterations  limited  to  the  posterior  columns, 
but  occupying  all  their  length  and  thickness,  or  only  the  whole  of 
the  lumbar  swelling,  there  is  an  impossibility  of  standing  or  walk- 
ing, depending  upon  the  loss  of  the  reflex  actions  of  the  limbs;  but 
that,  in  bed,  the  patients  in  such  cases  can  move  their  lower  limbs 
pretty  freely. 

3d.  That  there  is  no  loss  of  the  reflex  actions  of  the  limbs,  and 
that  the  voluntary  movements  persist  in  cases  of  alteration  of  the 
posterior  columns,  limited  to  a  small  part  of  their  length. 

Physiologists  and  medical  men  agree  in  admitting  that  deep 
alterations  of  the  anterior  columns  of  the  spinal  cord  always  cause 
a  more  or  less  complete  paralysis  of  voluntary  movements.     They 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  121 

may  be  right  in  this  view  as  long  as  we  consider  only  what  relates 
to  these  columns  in  the  dorsal  and  lumbar  regions ;  but,  as  we 
have  tried  to  prove,  by  experiments  on  animals  (see  Lecture  IV.), 
this  view  is  wrong  as  regards  the  anterior  columns  in  the  upper 
part  of  the  cervical  region.  Anatomy,  experiments  upon  animals, 
and  pathological  cases,  contribute,  each  and  all,  to  prove  that  the 
anterior  columns  in  the  neighborhood  of  the  medulla  oblongata  are 
not  the  channels  for  the  orders  of  the  will  to  muscles. 

In  the  first  place,  it  is  well  known  that  the  decussating  part  of 
the  anterior  pyramids  of  the  medulla  oblongata  is  almost  entirely 
composed  of  fibres  coming  from  the  lateral  columns  of  the  spinal 
cord.  Some  anatomists  have  even  gone  so  far  as  to  say  that  none 
of  the  decussating  fibres  of  the  pyramids  proceed  into  the  anterior 
columns  of  the  opposite  side.1  Now  experiments  have  shown  to 
me  that  the  section  of  the  anterior  columns  of  the  spinal  cord,  near 
the  medulla  oblongata,  does  not  affect,  in  a  very  marked  manner, 
the  voluntary  movements ;  while,  on  the  contrary,  a  section  of  the 
lateral  columns  usually  produces  a  complete  paralysis  of  the  volun- 
tary movements. 

Clinical  observation  teaches,  as  I  have  already  shown  (see  Lec- 
ture VIL),  that  an  alteration  of  a  lateral  half  of  the  pons  Varolii 
or  of  the  medulla  oblongata,  above  the  decussation  of  the  anterior 
pyramids,  causes  a  paralysis  of  voluntary  movements  in  the  oppo- 
site side  of  the  body,  and  not  at  all  in  the  corresponding  side. 
This  fact,  assuredly,  proves  that  the  decussation  of  the  fibres  em- 
ployed in  voluntary  movements  takes  place  entirely  below  the 
place  altered,  because  if  the  decussation  were  not  achieved  below 
this  place,  there  would  be  some  degree  of  paralysis  in  the  side  of 
the  body  corresponding  to  the  side  altered  in  the  basis  of  the  en- 
cephalon — which  is  not  the  case — and  the  paralysis  in  the  opposite 
side  would  not  be  complete,  which  also  is  not  the  case.  From 
these  facts  we  could,  therefore,  conclude  already,  that  the  anterior 
columns  of  the  spinal  cord  near  the  medulla  oblongata  are  not  the 
channels  for  the  orders  of  the  will  to  muscles,  as  anatomy  shows 
that  these  columns  do  not  decussate  in  the  lower  part  of  the  me- 
dulla oblongata.  It  might  be  said,  however,  that  these  columns, 
perhaps,  make  their  decussation  in  the  spinal  cord  itself;  but  this 
hypothesis  is  disproved  by  many  pathological  cases,  showing  that 

1  See  the  remarkable  paper  of  Dr.  J.  Reid,  on  the  Anatomy  of  the  Medulla  Ob- 
longata, in  his  "Physiological,  Anat.,  and  Pathol.  Researches,"  1848,  p.  307. 


122  THE    CENTRAL    NERVOUS    SYSTEM. 

an   alteration  of  a  lateral  half  of  the  spinal  cord  causes  a  loss  of 
voluntary  movements  only  in  the  corresponding  side. 

In  Fig.  22  may  be  seen  what  ought  to  be  the  results  of  an  altera- 
tion of  a  lateral  half  of  the  medulla  oblongata,  if  we  admit  one  of 
the  three  following  opinions :  1st.  That  the  anterior  columns  of 
the  spinal  cord  are  the  only  channels  for  voluntary  movements. 
2d.  That  the  lateral  columns  are  the  only  channels  for  these  move- 
ments. 3d.  That  these  two  parts  of  the  spinal  cord  have  almost 
an  equal  share  in  this  function. 

If  we  suppose  an  alteration  occupying  the  whole  lateral  half  of 
the  medulla  oblongata  (as  in  Cases  38  and  39),  the  loss  of  volun- 
tary movements  would  be  only  in  the  right  side  of  the  body,  if  the 
first  of  the  three  opinions  just  exposed  were  the  true  one;  on  the 
contrary,  we  find  that  the  paralysis  is  in  the  left  side  of  the  body. 
Were  the  third  opinion  the  true  one,  there  would  be  paralysis  in 
the  right  side  of  the  body,  on  account  of  the  alteration  of  the  ante- 
rior column  (a  a,  Fig.  22),  and  paralysis  in  the  left  side  on  account 
of  the  alteration  of  the  anterior  pyramid,  which  is  the  continuation 
of  the  left  lateral  column  of  the  spinal  cord.  This  is  not  what  takes 
place,  the  paralysis  being  only  in  the  left  side.  It  results  that  we 
must  admit  the  second  opinion — which  is,  that  the  lateral  columns 
of  the  spinal  cord,  near  their  decussation,  are  the  channels  for  the 
orders  of  the  will  to  muscles,  adding,  however,  that  most  probably 
there  are  some  conductors  for  this  influence  of  the  will  in  the  gray 
matter.  (See  Lecture  VII.) 

This  view  concerning  the  anterior  and  the  lateral  columns,  near 
the  medulla  oblongata,  is  also  borne  out  by  cases  of  disease  of  the 
spinal  cord,  as  well  as  by  cases  of  alterations  in  the  medulla  oblon- 
gata. I  will  relate,  as  a  decisive  proof,  a  very  interesting  case 
which  has  been  observed  and  published  by  one  of  the  most  able 
physiologists  of  our  age,  the  late  Dr.  John  Keid. 

Case  42. — G.  S ,  aged  thirty,  was  admitted  into  the  Infirmary 

of  Edinburgh,  on  the  29th  of  June,  1840.  For  many  months  he 
had  felt  pains  in  the  lumbar  region,  in  several  joints,  and  in  the 
back  of  the  neck,  and  his  head  was  turned  towards  the  right 
shoulder.  lie  had  pains  in  both  arms,  from  the  shoulder  to  the 
elbow,  and  the  forearm  and  hand  felt  numb  and  stiff.  He  com- 
plained much  of  cold  sweats.  Pulse,  quick  and  small.  On  the  7th 
of  July,  pulse  46.     On  the  11th  and  12th,  skin  warm.     In  August 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  123 

increased  headache.  The  symptoms  much  the  same  until  October, 
when  he  was  attacked  by  typhus  fever,  and  died.  He  was  able  to 
rise  up  to  stool  during  this  attack,  which  lasted  six  days. 

Autopsy. — The  spinal  cord  was  compressed  opposite  the  upper 
part  of  the  second  cervical  vertebra  by  a  conical  exostosis,  about 
one-third  of  an  inch  in  length,  growing  from  the  posterior  part  of 
the  root  of  the  odontoid  process.  This  exostosis  had  produced  a 
marked  depression  in  the  centre  of  the  spinal  cord,  immediately 
below  the  decussation  of  the  pyramidal  bodies.  On  cutting  into  the 
cord  at  this  part,  the  whole  of  the  central  portion  was  found  to 
consist  of  a  soft,  reddish-brown  pulp.  The  only  part  of  the  cord 
which  here  appeared  healthy,  was  a  thin  layer  of  the  lateral  por- 
tions, varying  in  thickness  in  different  parts,  but  in  some  places 
not  thicker  than  one  line.  (Physiol.,  Anal,  and  Pathol.  Researches, 
by  J.  Eeid,  1848,  p.  418.) 

Dr.  Eeid  says:  "In  this  case  we  find  that  though  the  whole  of 
the  central  portion  of  the  spinal  cord  was  in  a  state  of  ramollisse- 
ment,  from  the  effects  of  external  pressure,  the  portion  of  the  cord 
thus  altered  could  nevertheless  transmit"  downwards  the  motive 
influence  of  volition  and  of  the  excito-motory  respiratory  move- 
ments, and  convey  upwards  those  impressions  which  excite  sensa- 
tions." Dr.  Keid  does  not  say  when  he  ascertained  that  sensibility 
and  voluntary  movements  were  still  existing.  As  regards  volition, 
it  is  probable,  from  his  saying  that  five  days  before  death  "the  stools 
were  now  passed  in  bed,"  that  it  was  before  that  time  that  the  pa- 
tient had  been  able  to  rise  up  to  stool.  The  softening  found  was 
certainly  an  inflammatory  one,  and  it  is  most  probable  that  the 
inflammation  began  only  a  day  or  two  before  death.  But  there  is 
one  thing  beyond  question :  it  is  that  the  anterior  columns  of  the 
spinal  cord,  which  were  the  first  parts  exposed  to  the  pressure  from 
the  exostosis,  must  have  been  crushed  for  a  long  while.  In  this 
respect  this  case  is  a  decisive  one,  and  it  positively  proves  that 
near  the  medulla  oblongata  the  anterior  columns  contain  hardly 
any  fibre  used  in  voluntary  movements. 

As  a  complement  to  this  case,  we  might  relate  cases  showing  that 
an  alteration  of  the  anterior  part  of  the  medulla  oblongata  causes 
paralysis.  The  contrast,  indeed,  is  striking  between  the  case  of 
Dr.  Eeid  and  cases  of  alteration  of  the  anterior  pyramids  :  at  a  dis- 
tance of  a  few  lines  one  from  the  other,  an  alteration  of  the  ante- 
rior part  of  the  spinal  cord  hardly  causes  paralysis,  and  an  altera- 
tion of  the  anterior  pyramids,  on  the  contrary,  causes  a  complete 


124  THE    CENTRAL    NERVOUS    SYSTEM. 

paralysis.  So  it  was  in  many  cases,  and  particularly  in  one  recorded 
by  Dr.  E.  Bright,1  and  in  another  by  Professor  Lebert.2 

There  are  so  many  cases  on  record  in  which  the  anterior  columns 
of  the  spinal  cord  (in  the  lumbar  and  dorsal  regions  and  in  the 
lower  part  of  the  cervical  region),  were  alone  altered,  and  in  which 
the  voluntary  movements  were  lost,  and  many  of  these  cases  are 
so  well  known,  that  it  is  useless  to  relate  any  of  them.  We  will 
merely  say  that  the  paralysis  is  not  absolutely  complete  in  all  these 
cases. 

Before  we  leave  the  subject  of  paralysis  of  the  voluntary  move- 
ments, we  must  say  that  this  symptom  exists  also  in  cases  of  altera- 
tion of  the  gray  matter.  We  will  refer,  as  a  proof  of  the  correctness 
of  this  assertion,  to  the  cases  of  alteration  of  the  gray  matter  that 
we  have  related.  (See  Lecture  VI.,  Case  27,  and  several  others, 
which  are  mentioned  after  this  one,  and  Lecture  VII.,  Cases  28 
and  31.) 

In  summing  up  now  all  that  relates  to  paralysis  of  movement  in 
connection  with  the  alterations  of  the  various  parts  of  the  spinal 
cord,  we  find — 

1st.  That  it  is  not  an  essential  symptom  of  an  alteration  of  the 
posterior  columns. 

2d.  That  it  is  an  essential  symptom  of  an  alteration  of  the  ante- 
rior columns  everywhere,  except  in  the  upper  part  of  the  spinal 
cord,  near  the  medulla  oblongata. 

3d.  That  it  is  an  essential  symptom  of  an  alteration  of  the  lateral 
columns,  near  their  decussation  at  the  upper  part  of  the  spinal  cord, 
and,  perhaps,  not  in  the  other  parts  of  this  organ. 

4th.  That  it  is  an  essential  symptom  of  an  alteration  of  the  whole 
central  part  of  the  gray  matter. 

These  results  lead  to  the  conclusion  that  a  paralysis  of  voluntary 
movements  alone  could  not  be  of  service  in  the  diagnosis  of  the 
place  altered  in  the  spinal  cord ;  but  we  will  show  hereafter  that 
various  modifications  in  the  degree,  in  the  extent  and  place,  and  in 
the  kind  of  a  paralysis  of  voluntary  movements,  and  the  co-exist- 
ence of  this  symptom  with  others,  &c,  are  able  to  guide  more  or 
less  surely  in  the  diagnosis  of  the  seat,  and,  also,  of  the  nature  of 
an  alteration  in  the  spinal  cord. 

We  pass  now  to  conclusions  relating  to  the  different  kinds  of 

1  Reports  of  Medical  Cases,  vol.  ii.  p.  548-9. 

2  In  Traite  des  Maladies  de  la  Moelle,  by  Ollivier,  vol.  i.  p.  455. 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  125 

anaesthesia  in  cases  of  alteration  of  various  parts  of  the  spinal  cord. 
We  have  shown  that  a  loss  of  sensibility  is  not  a  symptom  depend- 
ing upon  an  alteration  of  the  posterior  columns  of  this  organ  in  any 
part  of  their  length,  and  that  this  symptom,  on  the  contrary,  chiefly 
belongs  to  alterations  of  the  central  gray  matter.  It  remains  to 
examine  if  there  is  some  difference  between  the  various  kinds  of 
sensitive  impressions  as  regards  their  place  of  passage  in  the  spinal 
cord. 

There  are  many  cases  on  record  showing  that  the  loss  of  each 
of  the  various  kinds  of  sensibility  of  the  skin  may  exist  alone,  the 
other  kinds  continuing  to  exist.  For  a  long  while  several  cases  of 
this  species  of  anaesthesia  have  been  known,  but  it  is  only  recently 
that  their  relation  with  alterations  of  the  spinal  cord  has  been  ob- 
served. 

We  think,  and  for  many  years  already  we  have  tried  to  prove, 
that  the  nerve-fibres  employed  in  the  transmission  of  each  of  the 
following  sensitive  impressions  are  as  distinct  one  from  the  other 
as  they  all  are  from  the  nerve-fibres  employed  in  the  transmission 
of  the  orders  of  the  will  to  muscles.  We  have  not  time  enough  to 
give  the  reasons  we  have  for  adopting  this  view :  we  will  merely 
state  that  of  the  three  hypotheses  that  may  be  made  to  explain  a 
loss  of  one  or  of  *a  few  only  of  the  following  sensations,  there  is  but 
one  which  agrees  with  the  facts  at  present  known ;  and  we  repeat 
that  this  one  is,  that  the  conductors  of  the  various  sensitive  impres- 
sions are  distinct  one  from  another.  The  kinds  of  sensitive  im- 
pressions which  have  different  conductors  are  those  giving  the 
sensations  of  touch,  tickling,  pain,  heat  and  cold,  and  the  peculiar  sen- 
sation which  accompanies  muscular  contraction. 

The  following  analysis  of  many  cases  of  alteration  of  the  spinal 
cord  shows  that  there  is  probably,  in  this  organ,  a  special  place  of 
passage  of  some  of  these  impressions,  and  that  their  principal  chan- 
nel is  the  gray  matter. 

1.  Loss  of  tactile  sensibility,  loss  of  the  faculty  of  feeling  pinch- 
ing, pricking,  and  the  passage  of  a  very  powerful  galvanic  current 
(and,  therefore,  loss  of  muscular  sensibility).  Persistence  of  the 
power  of  feeling  cold  and  tickling.  (See  for  the  autopsy,  Case  24, 
Lecture  VI.) 

From  this  case,  as  also  from  a  few  others,  we  can  draw  the  con- 
clusions: 1st,  that  the  conductors  of  the  impressions  of  cold  and 
tickling  do  not  pass  in  the  same  parts  of  the  spinal  cord  as  those  of 
the  other  sensitive  impressions;   2d,  that  the  conductors  of  cold 


126  THE    CENTRAL    NERVOUS    SYSTEM. 

and  tickling  impressions  are  not  excitable  by  a  galvanic  current,  as 
the  passage  of  a  powerful  current  in  the  skin  did  not  produce  the 
least  sensation. 

2.  Loss  of  feeling,  a  tickling,  or  a  contact.  Persistence  of  feeling 
of  pain.  No  mention  of  other  sensations.  (See  for  autopsy,  Case 
23,  Lecture  VI.) 

Here  also  we  have  a  proof  that  the  various  conductors  of  sensi- 
tive impressions  do  not  pass  in  the  same  part  of  the  spinal  cord  ; 
but,  unfortunately,  this  case,  like  the  preceding,  does  not  lead  to 
any  view  as  to  what  parts  are  employed  for  the  different  sensations. 
In  both  cases  the  cord  was  flattened  and  softened  by  tubercles 
pressing  upon  its  posterior  surface.  In  these  cases,  however,  the 
posterior  columns  of  the  cord  were  more  altered  than  any  other 
part,  as  the  tubercles  pressed  directly  upon  them.  We  are,  there- 
fore, entitled  to  draw  the  conclusion,  that  the  persisting  kinds  of 
sensibility  have  not  their  conductors  in  these  columns.  In  a  case 
recorded  by  my  friend,  M.  Laboulbene  (see  Case  22,  Lecture 
VI.),  not  only  were  the  posterior  columns  altered,  but  all  the  rest 
of  the  white  parts  of  the  spinal  cord,  and  the  various  kinds  of  sen- 
sibility persisted.  This  fact  shows  that  it  is  chiefly  in  the  gray 
matter  (which,  in  that  case,  was  not  altered),  that  the  various  sen- 
sitive impressions  pass. 

3.  Loss  of  tactile  sensibility  in  the  fingers  of  the  left  hand ; 
diminution  of  this  sensibility  in  the  two  upper  limbs,  and  particu- 
larly the  left  one.  Increased  sensibility  to  painful  impressions. 
(See  for  autopsy,  Case  13,  Lecture  V.) 

It  might  be  concluded  from  this  case,  that  tactile  impressions 
pass  through  the  posterior  columns  which  were  altered ;  but  the 
persistence  of  the  tactile  sensibility,  in  cases  of  alteration  of  these 
columns,  is  so  frequent  that  certainly  there  was  some  peculiar  alter- 
ation in  that  case  producing  that  kind  of  anaesthesia. 

4.  In  a  very  interesting  case,  recorded  by  Dr.  W.  Budd  (Medico- 
Chirurgical  Transactions,  vol.  xxii.  p.  170),  there  was  no  sensation 
produced  by  heat,  while  contact  was  felt.  The  spinal  cord  had 
been  injured  in  the  cervical  region;  but  the  patient  having  reco- 
vered, we  do  not  know  what  was  the  part  altered. 

5.  Loss  of  feeling  of  pain  or  pinching ;  diminished  sensibility  to 
cold  and  heat,  and  touch.  Fracture  of  the  seventh  cervical  verte- 
bra, and  softening  of  the  spinal  cord.  (Ollivier,  loc.  cit.,  vol.  i.  p. 
287.) 

Most  unfortunately,  medical  men  usually  neglect  noticing  the 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  127 

state  of  the  various  kinds  of  sensibility  in  cases  of  disease  of  the 
spinal  cord.  It  is  interesting,  therefore,  to  collect  the  cases  in 
which  there  is  mention  of  some,  if  not  all,  the  kinds  of  sensibility. 
We  give  here  a  list  of  some  of  such  cases. 

6.  Keturn  of  general  sensibility  of  the  skin  (probably  to  contact 
and  pain),  and  of  muscular  sense.  Local  destruction  of  posterior 
columns.  (See  Case  8,  Lecture  Y.) 

7.  All  kinds  of  sensibility  persisting.  Alteration  of  the  poste- 
rior columns.  (Case  9,  Lecture  Y.) 

8.  Scratching,  pricking,  and  pinching  the  skin  were  felt.  Alter- 
ation of  the  posterior  columns.  (Case  14,  Lecture  Y.) 

9.  Touch  and  painful  impressions  acutely  felt,  as  also  any  change 
of  temperature.  Alteration  of  the  posterior  columns,  and  slightly 
of  the  rest  of  the  cord.     (Case  16,  Lecture  Y.) 

10.  All  kinds  of  sensibility  persisting.  The  whole  of  the  white 
substance  of  the  cord  altered.     (Case  22,  Lecture  YI.) 

We  might  add  to  this  list  of  facts,  many  cases  of  alteration  of 
the  anterior  or  of  the  lateral  columns  of  the  spinal  cord,  in  which 
it  has  been  noted  that  touch,  heat  and  cold,  and  painful  impres- 
sions have  continued  to  be  felt.  But  it  is  unnecessary  to  mention 
cases  so  frequent  as  those  are. 

Now,  on  the  other  hand,  in  some  of  the  cases  of  alteration  of  the 
gray  matter  that  we  have  related  in  the  preceding  lectures,  it  has 
been  noted  that  there  was  a  loss  of  the  various  kinds  of  sensibility. 

From  this  review  of  facts,  it  results  that  what  we  have  said  of 
sensibility  generally,  may  be  applied  to  its  various  kinds.  The 
gray  matter  is  the  principal  channel  of  the  various  sensitive  impres- 
sions, and  the  posterior  columns  are  not  the  channels  for  any  kind 
of  these  impressions.  Therefore,  as  a  means  of  diagnosis  of  the 
place  where  an  alteration  exists  in  the  spinal  cord,  any  kind  of 
anaesthesia  cannot  be  considered  as  a  symptom  of  alteration  of  the 
posterior  columns;  while,  on  the  contrary,  the  loss  of  one  kind 
of  sensibility,  another  kind  remaining,  may  serve,  as  we  will  show 
hereafter,  as  a  means  of  diagnosis  of  an  alteration  of  the  gray  mat- 
ter of  the  spinal  cord. 

Before  proceeding  farther,  we  must  state  that  there  are  three 
series  of  facts  to  be  added  to  those  already  mentioned,  and  leading 
to  the  same  conclusions,  concerning  the  place  of  passage  of  the 
various  kinds  of  sensitive  impressions  in  the  spinal  cord.  The  first 
of  these  series  of  facts  includes  the  cases  of  alteration  of  a  lateral 
half  of  the  spinal  cord,  producing  anaesthesia  in  the  opposite  side 


123  THE    CENTRAL    NERVOUS    SYSTEM. 

of  the  body.  Of  course,  if  the  posterior  columns,  which  have  no 
decussation,  were  the  conductors  of  any  of  the  various  kinds  of 
sensitive  impressions  to  the  brain,  we  should  find  that  in  the  side 
injured  the  peculiar  kind  of  impressions  supposed  to  be  transmitted 
by  the  posterior  columns  is  no  more  transmitted;  while,  on  the  con- 
trary, transmission  should  continue  to  take  place  for  impressions 
made  upon  the  opposite  side  of  the  body.     But  it  is  not  so. 

In  the  first  place,  as  regards  the  two  kinds  of  sensitive  impres- 
sions which  are  usually  made — those  which  give  a  tactile  sensation 
and  a  sensation  of  pain — we  may  be  sure  that  the  posterior  columns 
are  not  their  conductors,  as  these  two  kinds  of  sensibility  existed 
in  the  side  injured,  and  were  lost  or  much  diminished  in  the  oppo- 
site side,  in  all  the  cases  of  alteration  of  a  lateral  half  of  the  spinal 
cord  that  we  know,  in  which  the  state  of  sensibility  in  the  two  sides 
of  the  body  has  been  noted.  (See  Cases  29,  30,  31,  35,  and  several 
others,  in  Lecture  VII.) 

In  the  second  place,  we  find  that,  of  the  other  kinds  of  sensibility, 
which  have  been  noticed  in  one  case,  the  same  thing  has  existed  as 
for  the  two  kinds  just  spoken  of.  Unfortunately,  however,  this  is 
a  case  in  which  the  injury  to  the  spinal  cord  is  not  exactly  known. 
Cold  and  heat  and  tickling  in  that  case  (see  Lecture  VII.,  Case  32), 
were  not  felt  on  the  side  opposite  to  that  of  the  principal  injury  to 
the  spinal  cord,  and  were  felt  on  the  corresponding  side.  It  seems, 
therefore,  that  the  conductors  of  the  various  kinds  of  sensitive  im- 
pressions decussate  in  the  spinal  cord,  and  consequently  that  none 
of  them  go  up  to  the  brain  along  the  posterior  columns  which  have 
no  decussation,  and  are  lying  close  beside  each  other,  unable  to 
have  communication  together  except  through  the  gray  matter.  It 
remains  to  be  known,  however,  at  what  place  the  decussation  exists 
for  the  conductors  of  the  various  kinds  of  sensitive  impressions. 
This  will  be  positively  determined  only  by  future  cases ;  but  we 
can  already  say  that  for  all  the  kinds  of  conductors,  except  one, 
the  place  of  decussation  seems  to  be  in  the  immediate  neighbor- 
hood of  the  entrance  of  the  posterior  roots  in  the  spinal  cord.  The 
conductors  of  the  kind  of  sensitive  impressions  that  originate  in 
muscles  when  they  contract — impressions  which,  on  being  felt, 
guide  our  movements — these  conductors,  perhaps,  decussate  very 
high  in  the  spinal  cord.  This  seems  to  be  shown  by  the  fact,  that 
in  most  of  the  cases  of  alteration  of  a  lateral  half  of  the  spinal  cord 
that  we  have  reported,  the  voluntary  movements  are  said  to  have 
been  free  in  the  opposite  side  of  the  body,  which  would  not  have 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  129 

existed  if  the  guiding  sensation  had  not  been  felt.  In  one  of  the 
cases,  however  (Case  37),  the  patient  had  lost  that  peculiar  muscu- 
lar sensibility  which  guides  voluntary  movements,  as  she  could  not 
hold  her  child  in  her  arm  when  she  did  not  look  at  that  arm.1  But 
as  we  do  not  know  what  was  the  precise  place  of  the  alteration  in 
this  case,  we  cannot  draw  a  positive  conclusion  from  it. 

We  shall  not  insist  on  the  second  and  third  series  of  facts  which 
militate  against  the  view  that  there  is  at  least  some  kind  of  sensi- 
tive impression  going  up  to  the  brain  along  the  posterior  columns 
of  the  spinal  cord.  These  columns  go  chiefly  to  the  cerebellum, 
and  a  small  part  only  of  their  fibres  pass  through  the  pons  Yarolii. 
Now,  we  find  that,  in  a  great  many  cases  of  alteration  of  the  cere- 
bellum, there  is  no  loss  of  any  hind  of  sensibility,  while,  on  the  con- 
trary, in  cases  of  alteration  of  the  pons  Yarolii,  there  is  a  loss  of 
all  kinds  of  sensibility;  and,  still  more,  the  loss  is  only  in  the  side 
of  the  body  opposite  to  the  side  of  the  alteration,  if  it  occupies  only 
a  lateral  half  of  the  pons.  These  two  series  of  facts  concerning  the 
cerebellum  and  the  pons  Yarolii,  united  with  the  facts  concerning 
the  medulla  oblongata  (see  Cases  38  and  39,  Lecture  VII.)  and  the 
spinal  cord,  constitute  such  a  mass  of  proofs  against  the  view  that 
the  posterior  columns  are  not  the  channels  to  the  brain  of  any  of 
the  various  kinds  of  sensitive  impressions,  that  we  think  it  useless 
to  insist  any  more  on  this  point.2 

From  the  above  discussion,  and  also  from  facts  that  we  have  not 
time  enough  to  relate,  we  draw  the  following  conclusions : — 

1  It  might  be  said  that  the  sensibility  of  the  skin  being  lost  in  this  case,  the 
impossibility  of  holding  the  child  arose  from  this  cutaneous  anaesthesia.  There 
is  a  decisive  reply  to  this  objection ;  it  is,  that  muscular  sensibility  alone  is  suffi- 
cient for  the  direction  of  voluntary  movements.  I  have  seen  a  child  completely 
deprived  of  cutaneous  sensibility  (unable  to  feel  contact,  pressure,  pricking, 
pinching,  tickling,  cold,  and  heat),  yet  able  to  walk  well  without  looking  at  his 
feet,  and  undoubtedly  owing  this  power  to  the  persistence  of  guiding  sensations  in 
the  muscles.  In  this  case,  besides  the  peculiar  sensibility  which  guides  voluntary 
movements,  the  muscles  had  the  power  of  giving  pain.  When  they  were  excited 
to  contract  spasmodically,  the  patient  had  the  feeling  of  pain  which  exists  in 
cramps. 

2  We  have  insisted  much  on  this  subject,  on  account  of  the  recent  assertions 
made  by  an  able  experimentalist,  M.  Moritz  Schiff,  who,  after  having  long  main- 
tained that  the  posterior  columns  transmit  tactile  and  painful  impressions,  has 
given  up  one-half  of  this  view,  and  now  affirms  that  they  transmit  tactile  impres- 
sions, while  the  gray  matter  transmits  painful  impressions.  Pathological  cases 
are  quite  in  opposition  to  this  view,  and  so  are  experiments  upon  animals,  as  we 
have  already  shown.  (See  Lecture  IV.) 

I 


130  THE    CENTRAL    NERVOUS    SYSTEM. 

1st.  Anaesthesia,  in  cases  of  disease  of  the  spinal  cord,  is  a  symp- 
tom indicating  that  the  gray  matter  is  altered.  This  conclusion 
seems  to  hold  good  also  with  respect  to  the  loss  of  each  of  the  va- 
rious kinds  of  sensibility. 

2d.  Alterations,  limited  to  either  of  the  white  columns  of  the 
spinal  cord,  do  not  cause  anaesthesia  of  any  kind. 

8d.  Anaesthesia,  limited  to  one-half  of  the  body,  in  cases  of  dis- 
ease of  the  spinal  cord,  is  a  symptom  indicating  that  the  gray  mat- 
ter in  the  opposite  half  of  the  cord  is  altered,  except  in  cases  of 
which  we  will  now  say  a  few  words. 

We  have  said  already  that  anaesthesia  alone — i.  e.,  without  a  pa- 
ralysis of  voluntary  movements— is  not  a  symptom  of  disease  of 
the  spinal  cord,  or  at  least  of  ordinary  diseases  of  the  organ,  as  we 
have  riknowledged  that  there  are  two  kinds  of  alterations  that 
might  produce  a  much  more  marked  anaesthesia  than  a  paralysis  of 
"voluntary  motion,  and  even,  perhaps,  diminish  voluntary  move- 
ments almost  only  on  account  of  the  anaesthesia  produced.  One  of 
these  alterations  would  be  an  injury  or  a  morbid  transformation 
all  along  the  posterior  horns  in  which  the  posterior  roots  pass  be- 
fore going  to  the  other  parts  of  the  spinal  cord.  In  such  a  case 
there  would  be  anaesthesia  on  the  side  where  the  alteration  exists, 
if  it  is  limited  to  one  side  of  the  cord,  and  the  loss  of  sensibility 
would  be  localized  to  those  parts  which  receive  their  sensitive 
nerve-fibres  from  the  regions  altered;  so  that,  below  and  above, 
sensibility  might  exist.  We  do  not  know  of  a  single  case  of  this 
kind ;  some,  however,  may  have  been  observed. 

The  other  cause  of  anaesthesia,  without  paralysis  of  voluntary 
movements,  consists  in  an  injury  to  the  decussating  conductors  of 
sensitive  impressions  in  the  spinal  cord.  Suppose,  for  instance,  a 
sword  introduced  from  below  upwards,  or  in  the  opposite  direction, 
in  the  spinal  cord,  and  dividing  this  organ  in  its  two  lateral  halves, 
and  producing  as  little  injury  as  possible  to  its  anterior  columns. 
The  decussating  fibres  being  then  divided,  sensibility  would  be  lost 
in  all  the  parts  of  the  body  from  which  these  fibres  come.  It  is 
hardly  possible  to  conceive  the  production  of  such  an  injury,  which 
is  made  with  so  much  difficulty  even  in  experimenting.  But  some- 
times disease  causes  almost  this  kind  of  injury;  for  instance,  a 
softening  beginning  in  the  very  place  where  the  decussation  exists; 
or  a  slow  increase  of  the  amount  of  water  in  the  central  canal  of 
the  spinal  cord  may  produce  a  greater  diminution  of  sensibility 
than  of  voluntary  movements.     This  is  what  occurs  not  rarely  in 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  131 

the  beginning  of  softening  of  the  spinal  cord,  and  in  cases  of  spina 
bifida  with  hydrorachis.  It  would  be  very  interesting  to  look  for 
this  symptom  in  cases  of  diplomyelia.  Our  learned  friend  Mr.  De- 
paul  has  seen  sensibility  lost  and  voluntary  movements  partly  pre- 
served, in  a  case  of  division  of  the  spinal  cord  (diplomyelia).  This 
is  a  fact  well  worthy  of  attention,  as  it  realizes  in  man  what  is 
shown  in  the  most  important  of  the  experiments  which  I  have 
shown  in  the  preceding  lectures. 

"We  do  not  need  to  say  that  anaesthesia  may  be  due  to  alterations 
of  the  posterior  roots,  and  to  the  nerve-fibres  of  the  various  sensi- 
tive nerves  in  any  part  of  their  length.  We  do  not  need,  also,  to 
remind  our  hearers  that  anaesthesia  may  be  due  to  diseases  of  the 
encephalon,  to  poisoning  by  lead,  arsenic,  belladonna,  &c.  But 
there  is  a  kind  of  anaesthesia  which  is  much  less  known,  and  about 
which  we  must  say  a  few  words.  This  peculiar  anaesthesia  depends 
upon  a  morbid  reflex  action ;  it  may  arise  in  diseases  of  all  the 
viscera,  and  also  from  irritations  upon  any  sensitive  nerve,  in  any 
part  of  its  course.  If  time  allows,  we  will,  in  another  lecture,  give 
many  illustrations  of  this  kind  of  anaesthesia ;  at  present,  we  will 
merely  relate  a  curious  case  as  an  example  of  this  affection. 

Case  43. — A  man  became  paralyzed  of  sensibility  in  the  whole 
left  side  of  the  body.  Voluntary  movements  were  only  diminished. 
He  stated  that,  fifteen  years  before,  he  had  received  a  shot  in  the 
left  side  of  the  lumbar  region.  The  ball  had  met  with  the  last  rib, 
followed  it  beneath  the  skin,  and  gone  out  at  the  level  of  the  first 
lumbar  vertebra,  which,  probably,  had  been  fractured.  The  wounds 
quickly  healed ;  but  hardly  had  this  taken  place,  when  the  patient 
perceived  that  a  loss  of  sensibility  began  in  the  neighborhood  of 
the  cicatrix,  and  gradually  extended  from  that  to  other  parts.  The 
wound  in  the  lumbar  region  was  opened,  and  sensibility  reappeared, 
and  from  this  time  he  was  well :  but  at  every  time  cicatrization 
was  near  being  completed,  he  had  threatening  of  a  return  of  anaes- 
thesia. At  last  the  wound  healed  definitively,  and  then  his  condi- 
tion was  as  above  described.  Four  blisters  in  the  neighborhood  of 
the  scar  cured  him.  (Roche,  in  Archives  de  Medec,  Fev.  1823,  vol.  i.  p. 
262 ;  and  in  Ollivier,  loco  cit.,  vol.  i.  p.  360.) 

This  case  assuredly  is  not  an  instance  of  anaesthesia  due  to  an 
injury  of  the  spinal  cord,  as  the  alteration,  if  there  has  been  any  in 
this  organ,  was  in  the  lumbar  region,  and  the  loss  of  sensibility  was 
in  the  whole  left  side  of  the  body.    Anaesthesia  in  this  case  was  the 


132  THE    CENTRAL    NERVOUS    SYSTEM. 

result  of  a  reflex  influence  on  the  nutrition  of  the  sensitive  nerves 
of  the  left  side,  due  to  an  irritation  of  the  sensitive  nerve-fibres  of 
the  first  lumbar  nerve,  as  we  shall  prove  in  another  lecture. 

M.  H.  Romberg1  lays  great  stress  upon  interesting  facts  recorded 
by  Daniellsen  and  Bceck,  to  prove  that  alterations  of  the  posterior 
columns  of  the  spinal  cord  cause  anaesthesia.  It  would  be  easy  to 
show  that  no  conclusion  of  this  kind  can  be  drawn  from  the  facts 
observed  by  these  physicians.  In  their  important  work  upon  Ele- 
phantiasis Graecorum,2  they  state  that  the  posterior  roots  of  the 
spinal  nerves,  and  also  the  gray  matter,  are  altered,  and  that  some- 
times the  whole  of  the  spinal  cord  is  atrophied  or  hardened — 
alterations  which  sufficiently  explain  the  anaesthesia  observed  in 
leprosy. 

We  now  pass  to  another  question,  which  is :  How  is  it  that  sen- 
sibility is  not  lost  in  some  parts  of  the  body,  in  cases  of  consider- 
able alteration  of  parts  of  the  spinal  cord ;  which  we  admit  to  be 
conductors  of  sensitive  impressions?  We  have  already  given  a 
solution  to  this  question,  by  experiments  which  we  have  mentioned 
in  one  of  the  preceding  lectures.  (See  Lecture  IV.)  Taking  notice 
only  of  the  conductors  of  painful  impressions,  we  may  imagine 
them  scattered  in  the  spinal  cord,  without  any  order  whatever,  or 
having  there  one  of  the  two  following  dispositions :  they  may  be 
so  distributed,  that  those  coming  from  the  anterior  surface  of  the 
body  form  a  distinct  layer  in  the  cord,  and  so  on  for  those  from 
the  posterior  surface,  or  for  any  other  longitudinal  part  of  the 
body ;  or  they  may  be  arranged  so  that  each  layer  of  conductors, 
in  the  spinal  cord,  contains  conducting  elements  from  the  anterior, 
the  middle,  and  the  posterior  parts  of  the  body.  This  last  disposi- 
tion is  the  one  that  seems  to  exist  according  to  our  experiments 
and  to  pathological  cases.  In  this  respect,  pathology  clearly  shows 
that  an  alteration,  of  any  limited  part  of  the  zone  of  the  spinal  cord, 
by  which  sensitive  impressions  are  transmitted  to  the  encephalon, 
does  not  produce  anaesthesia,  in  any  limited  part  of  the  body,  below 
the  place  where  the  alteration  lies.  Pathology  shows,  on  the  other 
hand,  that,  when  incomplete  anaesthesia  exists,  it  is  in  the  same  de- 
gree or  very  nearly  so  in  all  the  parts  which  receive  their  sensitive 
nerves  below  the  place  altered,  and  whatever  may  be  the  part  of 
the  conducting  zone  that  is  altered.     If  any  part  of  the  skin,  for 

1  Lehrbuch  der  Nervenkrankheiten,  Bd.  i.  3d  ed.,  1853,  p.  317  et  seq. 

2  Traite  de  la  Spedalskhed,  Paris,  1848,  pp.  283-286. 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  133 

instance,  is  connected  with  the  sensorium  by  a  hundred  conductors 
of  sensitive  impressions,  these  conductors  are  not  in  a  bundle  in 
the  spinal  cord ;  they  seem  also  not  to  be  scattered  without  order 
in  several  parts  of  this  organ.  On  the  contrary,  we  may  deduce 
from  vivisections  and  pathological  facts,  that  they  are  distributed 
in  good  order  in  all  the  parts  of  the  conducting  zone  of  the  spinal 
cord. 

In  this  way  we  can  explain  easily  why  sensibility  is  so  rarely 
lost  in  cases  of  deep  alteration  of  the  spinal  cord.  But  there  is 
another  cause  to  be  added  to  this  one,  and  explaining  why  anaes- 
thesia may  seem  not  to  exist,  where  even  one  third,  one-half,  or 
more  of  the  conductors  of  sensitive  impressions  have  been  altered 
so  much  that  they  lose  their  function  entirely.  This  is  the  hyper- 
aesthesia,  to  which  it  is  due  that  the  sensitive  impressions,  trans- 
mitted by  the  remaining  conductors,  are  felt  with  such  an  inten- 
sity that  the  cause  of  diminution  of  sensibility  is  more  than  com- 
pensated. 

It  seems  extremely  probable  that,  in  a  certain  measure,  what  we 
have  just  said  of  painful  impressions,  is  true  also  of  the  other  kinds 
of  sensitive  impressions ;  but  pathology  shows  that,  besides  a  dis- 
tribution of  many  of  their  conductors,  in  various  parts  of  .the  con- 
ducting zone  of  the  spinal  cord,  there  is  a  place,  and  a  special  one, 
for  each  kind  of  these  impressions,  where  there  is  an  aggregation 
of  many  of  their  conductors.  Much  is  to  be  discovered  in  this 
respect,  and  I  hope  that  the  opportunities  of  throwing  light  on  this 
subject  will  not  exist  in  vain  in  the  future. 

We  may  deduce,  from  the  preceding  discussion,  that  anaesthesia, 
existing  in  a  limited  part  of  the  body,  whether  alone  or  with  para- 
lysis of  voluntary  movements,  cannot  be  considered  as  a  symptom 
of  a  local  affection  of  the  spinal  cord,  unless  it  be  an  alteration  of 
the  posterior  gray  horns  destroying  the  posterior  roots  at  their 
place  of  entrance,  or  an  alteration  of  the  gray  matter  in  its  centre 
destroying  the  conductors  of  sensitive  impressions  at  the  place  where 
they  decussate  on  the  median  line.  (See  Case  28,  Lecture  VII.) 

There  is  a  symptom  of  disease  of  the  spinal  cord,  the  study  of 
which  is  full  of  interest,  both  in  a  physiological  and  a  practical 
point  of  view:  I  mean  the  referring  to  the  peripheral  termination 
of  conductors  of  sensitive  impressions,  the  impressions  made  on 
them  in  any  part  of  their  length.  As  regards  the  trunks  of  nerves, 
it  is  well  known  that  usually  impressions  on  them  are  referred  to 
the  periphery.    We  have  no  time  now  to  examine  why  it  is  usually 


134  THE    CENTRAL    NERVOUS    SYSTEM. 

so,  and  why,  in  so  many  cases,  there  are  exceptions  to  this  law. 
We  will  only  examine  what  relates  to  the  spinal  cord  concerning 
this  phenomenon. 

Taking  as  true  for  a  moment  the  old  view  that  the  spinal  cord 
contains  nerve-fibres,  which  are  the  continuation  of  those  of  the 
posterior  roots  and  of  the  nerves  of  the  sensitive  parts  of  the  body, 
and  possessing  the  same  properties  in  this  nervous  centre  as  in  these 
roots  and  nerves,  what  ought  to  be  the  result  of  pressure  on  this 
organ?  According  to  the  seat  of  the  pressure,  there  ought  to  be 
pain  felt  as  if  it  originated  from  a  more  or  less  considerable  part  of 
the  body.  "We  have  read  carefully  the  details  of  a  great  many 
cases  of  fracture  or  luxation  of  the  spine,  or  of  tumors  pressing 
upon  the  spinal  cord ;  we  have  also  carefully  questioned  many 
patients,  and  we  can  state  that  the  referring  to  the  periphery  is  rare, 
and  that  it  never  exists  unless  the  posterior  roots  are  irritated  or 
the  spinal  cord  inflamed. 

There  is  a  remarkable  fact  concerning  this  error  loci,  in  regard  to 
the  place  irritated.  The  gray  matter  is  not  excitable  in  its  normal 
condition,  so  that  a  pressure  upon  it  cannot  give  origin  to  any  sen- 
sation, and  it  is  therefore  very  natural  that  a  fractured  or  dislocated 
bone,  pressing  even  much  upon  the  whole  spinal  cord,  and  conse- 
quently upon  its  gray  matter,  should  not  cause  sensations  referred 
to  all  the  parts  of  the  body  below  the  place  compressed.  But  when 
inflammation  has  set  in,  it  is  not  rare  that  this  gray  matter  acquires 
the  property  of  being  excitable,  and  that  then  the  pressure  acts 
upon  this  matter,  and  causes  that  peculiar  feeling  called  formication, 
and  sometimes  a  pain,  the  character  of  which  varies  very  much. 

The  referring  of  sensations  to  the  periphery  of  the  body,  in  dis- 
eases of  the  spinal  cord,  is  a  fact  of  great  practical  value.  I  hope, 
therefore,  I  shall  be  allowed  to  say  a  few  words  more  on  this  subject. 

If  we  inquire  into  the  differences  between  the  various  conductors 
of  the  five  kinds  of  sensitive  impressions  that  may  come  from  the 
different  parts  of  the  body,  leaving  aside  the  four  higher  senses  and 
the  peculiar  sensation  given  by  the  genital  organs,  we  find  that,  as 
regards  their  excitability,  they  differ  extremely  in  different  parts  of 
their  length,  and  also  one  from  the  other.  We  have  shown,  nearly 
six  years  ago,1  that  the  degree  of  excitability  of  the  conductors  of 
painful  impressions  varies  very  much  in  the  different  parts  of  their 
length :  they  have  no  excitability  in  the  central  gray  matter  of  the 

1  Experimental  Researches  applied  to  Physiology  and  Pathology.  New  York, 
1853,  p.  98. 


CONCLUSIONS    FROM    PATHOLOGICAL    CASES.  135 

cord,  and  they  have  the  maximum  of  excitability  in  the  part  of  the 
posterior  roots  attached  to  the  cord,  and  the  minimum  in  their 
passage  through  the  ganglions.  But  it  seems  that  some  of  them, 
ending  in  bones,  in  muscles,  &c,  have  no  excitability,  except  in 
their  peripheric  extremity;  at  least,  when  we  press  upon  the  trunk 
of  a  nerve  in  the  arm  or  the  leg,  we  find  that  there  is  but  very  little 
pain,  if  any,  referred  to  muscles,  bones,  and  some  other  parts.  It 
seems  probable,  therefore,  that  a  number  of  conductors  of  painful 
impressions  have  no  excitability — at  least,  to  a  mechanical  irrita- 
tion— in  some  parts  of  their  length,  in  nerves. 

As  regards  the  conductors  of  the  other  kinds  of  sensitive  impres- 
sions, they  seem  to  have  no  excitability  at  all,  in  the  normal  con- 
dition, in  any  part  of  their  length,  except  at  their  termination  in 
the  skin  or  in  muscles.  E.  H.  Weber  has  shown,1  that  in  a  part 
that  has  lost  its  skin,  there  is  a  loss  of  feeling  cold,  heat,  and  touch. 
Perhaps,  however,  it  would  be  right  to  make  an  exception  for  the 
conductors  of  impressions  of  tickling,  in  the  trunks  of  nerves,  as  a 
certain  degree  of  pressure  upon  them  gives  a  feeling  of  tickling  that 
we  refer  to  the  periphery.  But  whatever  may  be  admitted  in  regard 
to  this  fact,  there  is  something  concerning,  not  only  this  kind  of 
conductors,  but  also  all  the  others,  which  seems  quite  certain.  It 
is,  that  they  all  may  acquire,  particularly,  if  not  exclusively,  under 
the  influence  of  inflammation,  the  power  of  being  excitable,  and  of 
giving  sensitive  impressions  which  are  referred  to  the  periphery. 
This  change  may  take  place  in  all  their  length,  from  their  terminal 
ramification  in  the  different  parts  of  the  body,  to  their  origin  in 
different  parts  of  the  brain — i.  e.,  in  the  branches  and  trunks  of 
nerves,  in  the  gray  matter  of  the  spinal  cord,  in  the  medulla 
oblongata,  the  pons  Varolii,  and  most  of  the  other  parts  of  the 
encephalon.  This  is  true  with  respect  to  the  conductors  of  the 
guiding  muscular  sensations,  as  also  those  of  impressions  of  cold  and 
heat,  as  well  as  the  other  kinds  of  conductors.  If  I  had  time,  I 
could  relate  many  cases  in  proof  of  this  assertion.  I  will  only 
mention  two  or  three  at  present,  and  I  will  point  out  some  others 
when  I  treat  of  the  medulla  oblongata  and  pons  Varolii. 

In  an  interesting  case  of  tumor  in  the  midst  of  the  cauda  equina, 
and  pressing  particularly  on  the  posterior  roots  of  the  nerves  of 
the  left  lower  limb,  there  was  a  complete  loss  of  sensibility  in  this 
limb ;  nevertheless,  the  patient  complained  strongly  of  a  feeling  of 

1  Wagner's  Handworterbuch  der  Physiol.,  vol.  iii.  Part  ii.  1846,  p.  498. 


136  THE    CENTKAL    NERVOUS    SYSTEM. 

heat  in  the  parts.     (Dr.  W.  W.  Fisher,  in  Trans,  of  the  Prov.  Assoc., 
vol.  x.,  and  in  Philad.  Med.  Examiner,  1842,  p.  361.) 

In  a  case  recorded  by  Gall  (Sur  les  Fonctions  du  Cerveau,  vol.  vi. 
1825,  p.  284),  there  was  the  feeling  of  a  burning  fire  in  the  chest, 
the  throat,  and  the  tongue ;  the  anterior  parts  of  the  spinal  cord 
were  very  much  inflamed,  in  the  cervical  and  in  the  lumbar 
regions. 

In  a  case  of  fracture  of  the  twelfth  dorsal  vertebra,  with  consi- 
derable compression  of  the  spinal  cord,  there  was  complete  loss  of 
sensibility,  with  a  sense  of  burning  in  the  legs.  (Case  recorded  by 
Dr.  Gay,  in  A  Descriptive  Catalogue  of  the  Boston  Museum,  by  J.  B. 
S.  Jackson,  1847,  p.  30.) 

It  is  of  some  importance,  for  the  diagnosis  of  the  locality  of 
disease  in  the  spinal  cord,  to  bear  in  mind  that  sensations  felt  as  if 
they  came  from  the  periphery,  whatever  be  their  kind,  are  not  due 
to  some  irritation  of  the  posterior  columns,  but  to  changes  that 
take  place  in  the  gray  matter,  in  consequence  of  an  inflammation. 
This  is  the  general  conclusion  to  be  drawn  from  all  the  facts  I 
know  concerning  sensations  referred  to  the  periphery  in  cases  of 
alteration  of  the  spinal  cord. 

I  should  like  to  speak  of  the  various  other  symptoms  of  disease 
of  the  spinal  marrow;  but,  as  I  have  but  little  time,  and  also  as  I 
shall  have  another  opportunity  of  explaining  some  of  these  symp- 
toms (such  as  hyperesthesia,  convulsions,  cramps,  and  reflex  actions), 
I  will  pass  at  once  to  the  enunciation  of  the  groups  of  symptoms 
existing  in  the  cases  of  disease  of  the  spinal  cord,  according  to  the 
place  and  extent  of  the  alteration.  I  leave  aside  the  symptoms 
concerning  the  movements  of  the  heart,  respiration,  the  state  of  the 
sphincters,  animal  heat,  and  nutrition. 

1st.  Deep  alteration  of  the  posterior  columns  in  all  their  length. — 
Increased  sensibility  in  the  trunk  and  limbs  for  impressions  of 
touch,  or  due  to  pricking,  pinching,  and  galvanic  excitations,  and 
for  changes  of  temperature  (cold  and  heat).  Loss,  or  a  very  great 
diminution,  of  reflex  movements.  All  kinds  of  voluntary  move- 
ments possible,  and  more  or  less  easily  executed  when  the  patient 
is  in  bed.     Walking  and  standing  very  difficult.1 

1  On  account  of  the  loss  of  reflex  action,  and  of  the  morhid  sensibility,  and  also 
on  account  of  the  alteration  in  the  guiding  sensations  coming  from  muscles — altera- 
tion -which  is  due  to  two  causes,  one  of  which  is  the  loss  of  action  of  some  of  these 
conductors  altered  in  the  posterior  columns  through  which  they  pass  before  reach- 
ing the  gray  matter,  while  the  other  is  the  morbid  increase  of  sensibility  of  those 
conductors  which  go  directly  into  gray  matter. 


CONCLUSIONS    FROM   PATHOLOGICAL    CASES.  137 

2d.  Deep  alteration  of  the  posterior  columns  in  the  extent  of  the  cervico- 
branchial  swelling. — Increased  sensibility  in  the  four  limbs,  and  in 
the  trunk,  for  all  kinds  of  impressions.  Diminution  of  reflex  actions 
in  the  upper  limbs,  and  increased  reflex  actions  in  the  lower  limbs. 
Some  difficulty  in  the  direction  of  the  movements  of  the  upper 
limbs,  without  the  help  of  the  sight.  Standing  and  walking  possible 
without  any  great  difficulty. 

3d.  Deep  alteration  of  the  posterior  columns  in  the  extent  of  the  dorso- 
lumbar  swelling. — Increased  sensibility  in  the  lower  limbs,  and 
normal  sensibility  in  the  upper  ones.  Diminution  or  loss  of  reflex 
actions  in  the  lower  limbs.  Movements  of  lower  limbs  possible, 
and  even  easy,  when  the  patient  is  in  bed ;  but  walking  and  stand- 
ing very  difficult. 

4th.  Deep  alteration  of  a  very  limited  part  of  the  posterior  columns. — 
Increased  sensibility,  and  increased  reflex  action,  in  all  parts  re- 
ceiving their  nerves  from  the  spinal  cord  below  the  alteration. 
Voluntary  movements  possible,  and  even  easy,  everywhere.  The 
place  of  the  alteration  may  be  detected  by  diminution  of  reflex 
actions  in  the  zone  round  the  body  receiving  nerves  from  the  level 
of  the  part  altered  in  the  posterior  columns. 

5th.  Alteration  of  the  posterior  columns  and  posterior  roots  of  the 
spinal  nerves. — Instead  of  hyperesthesia,  as  in  the  preceding  cases, 
diminution  or  loss  of  all  kinds  of  sensibility,  in  places  receiving 
the  spinal  nerves,  which  are  the  continuation  of  the  altered  roots. 
Voluntary  movements  still  possible,  in  bed,  and  while  the  patient 
looks  at  his  limbs,  but  walking  and  standing  almost  impossible. 
Keflex  actions  completely  lost  in  all  the  anaesthetic  parts.  If  the 
alterations  are  in  the  upper  parts  of  the  spinal  cord,  the  other  parts 
being  healthy,  then  voluntary  movements  in  the  lower  limbs,  and 
even  walking  or  standing,  are  possible,  and  may  be  easy,  and  these 
limbs  have  an  increased  sensibility  and  increased  reflex  actions. 

6th.  Alteration  of  the  posterior  columns  and  of  the  gray  matter  in  all 
their  length. — There  is  no  difference  between  this  case  and  the  pre- 
ceding, except  that  here  there  is  a  real  paralysis  of  voluntary  move- 
ments, which  is  complete  if  the  alteration  extends  to  the  anterior 
gray  cornua.  Greater  frequency  of  formication  and  of  other  sensa- 
tions referred  to  the  periphery. 

7th.  Alteration  of  the  posterior  columns  and  gray  matter  in  any 
limited  part  of  the  spinal  cord. — Very  nearly  complete  loss  of  sensi- 
bility. Degrees  of  paralysis  of  voluntary  movements  varying  with 
the  place  occupied  by  the  alteration  in  the  length  of  the  spinal  cord. 


138  THE    CENTRAL    NERVOUS    SYSTEM. 

Keflex  actions  increased  in  parts  receiving  their  nerves  from  the 
portions  of  the  cord  below  the  seat  of  the  alteration. 

8th.  Alteration  limited  to  the  gray  matter. — The  same  symptoms  as 
in  the  preceding  cases,  except  that  at  first  there  is  a  greater  degree 
of  anaesthesia  than  of  paralysis,  if  the  alteration  begins  in  the  very 
centre  of  the  cord.  Formication  and  other  sensations  referred  to 
the  periphery,  in  cases  of  inflammation. 

9th.  Alteration  of  the  anterior  columns  in  the  upper  part  of  the 
cervical  region. — No  paralysis,  no  anaesthesia,  very  slight  hyperes- 
thesia, various  sensations  (particular  pain)  referred  to  several  parts 
of  the  body. 

10th.  Alteration  of  the  lateral  columns  in  the  upper  part  of  the 
cervical  region. — Paralysis  of  voluntary  movements  in  the  four  limbs 
and  the  trunk.  Increased  sensibility  and  greatly  increased  reflex 
actions  in  the  paralyzed  parts. 

11th.  Alteration  of  the  anterior  columns  in  any  part  of  their  length, 
except  the  neighborhood  of  the  medulla  oblongata. — More  or  less  com- 
plete paralysis  of  voluntary  movements  in  all  the  parts  receiving 
their  nerves  from  or  below  the  parts  of  the  cord  where  the  altera- 
tion exists.  Slight  hyperesthesia.  Keflex  actions  very  much  dimi- 
nished in  the  parts  which  receive  their  nerves  from  the  altered 
portion  of  the  cord,  and  increased  below  these  parts. 

12th.  Alteration  of  the  lateral  columns  in  any  part  of  their  length, 
except  the  neighborhood  of  the  medulla  oblongata. — Incomplete  para- 
lysis of  movements.  Hyperesthesia.  Diminution  of  reflex  actions 
less  than  in  the  preceding  case. 

18th.  Alteration  of  the  anterior  half  of  the  spinal  cord,  including  the 
anterior  columns,  a  good  part  of  the  gray  matter,  and  a  part  of  the 
lateral  columns. — Voluntary  movements  completely  paralyzed.  Sen- 
sibility very  much  diminished.     For  reflex  actions,  as  in  11th. 

14th.  Alteration  of  the  various  parts  of  the  sp>inal  cord,  except  the 
posterior  columns. — Loss  of  voluntary  movements  and  of  all  kinds  of 
sensibility.  Keflex  actions  increased  or  diminished  in  certain  parts 
of  the  body,  according  to  the  place  of  the  alteration  in  the  length 
of  the  spinal  cord. 

I  know  many  cases  in  which  one  of  the  two  last  kinds  of  altera- 
tion has  existed.  In  another  lecture,  I  will  relate  three  of  them, 
which  have  been  recorded  by  Mr.  Caesar  Hawkins,  by  Dr.  John  W. 
Ogle,  and  by  Dr.  T.  Inman. 


139 


LECTURE   IX. 

ON  THE  PHYSIOLOGICAL  AND  MORBID  ACTIONS  DUE  TO  THE 
GREAT  SYMPATHETIC  NERVE. 

Effects  of  a  section  of  the  sympathetic  nerve  in  the  cervical  region. — Effects  of  the 
excitation  of  the  same  nerve,  in  the  same  region,  by  a  galvanic  or  an  electro- 
magnetic current. — Almost  all  the  effects  due  to  the  section  or  galvanization  of 
this  nerve  are  owing  to  the  condition  of  bloodvessels  after  these  operations. — 
The  sympathetic  nerve  originates  chiefly  from  the  cerebro-spinal  axis. — Simili- 
tude between  the  effects  of  a  section  of  the  sympathetic  nerve,  and  those  of  a 
section  of  a  lateral  half  of  the  spinal  cord. — Persistence  of  a  contraction  of 
bloodvessels  due  to  irritation  of  the  cerebro-spinal  axis  in  certain  diseases. — 
Two  kinds  of  normal  or  morbid  influences  of  the  nervous  system  upon  nutri- 
tion, secretion,  &c. ;  one  upon  bloodvessels,  the  other  upon  tissues. 

T  pass  now  to  quite  a  different  subject.  In  the  preceding  lec- 
tures, I  have  chiefly  examined  what  relates  to  voluntary  movements 
and  sensibility;  I  come  now  to  the  influence  of  the  nervous  sys- 
tem upon  nutrition,  animal  heat,  secretions,  &c,  and  I  begin  by  the 
peculiar  influences  of  the  sympathetic  nerve  on  these  functions  in 
health  and  disease. 

Before  entering  into  the  subject  of  the  influence  of  the  nervous 
system  upon  the  functions  of  organic  life,  it  is  necessary  to  state 
what  are  the  effects  of  the  section  and  of  the  galvanization  of  the 
cervical  sympathetic  nerve.  I  hope  I  may  be  allowed  to  fix  some 
dates  of  publication  of  the  principal  discoveries  in  this  respect. 
Prof.  CI.  Bernard  published  the  results  of  his  first  researches  on 
the  effects  of  the  section  of  the  cervical  sympathetic  nerve  in  1851, 
and  in  the  beginning  of  1852.1  The  only  great  fact  announced  in 
these  publications  was,  that  this  section  was  constantly  followed  by 
a  considerable  afflux  of  blood  in  the  parts  of  the  head  to  which  the 
sympathetic  goes.  Led  by  experiments  that  I  had  made  several 
years  before,  with  my  friend  Dr.  Tholozan,  on   the  influence  of 

1  Comptes  rendus  de  la  Soc.  de  Biol.,  Dec.  1851,  in  Gaz.  Med.,  1852,  p.  74.— 
Comptes  rendus  de  l'Acad.  des  Sciences ;  seance  du  29  Mars,  1852. 


140  THE    CENTKAL    NEEVOUS    SYSTEM. 

nerves  on  bloodvessels,  I  understood  at  once  that  the  fact  disco- 
vered by  Prof.  Bernard  was  due  to  the  paralysis  of  the  bloodves- 
sels after  the  section  of  the  sympathetic;  and  I  thought  that,  if  this 
view  were  right,  I  should  find  galvanization  of  this  nerve  produc- 
ing the  reverse  of  the  effects  of  the  section.  The  experiment  being 
made,  I  found,  as  I  had  foreseen,  that  the  bloodvessels  contracted, 
and  that  the  quantity  of  blood  and  the  temperature  diminished. 
The  date  of  my  first  publication  is  Aug.  1st,  1852.1  Three  or  four 
months  afterwards,  Prof.  Bernard  not  knowing  what  I  had  done, 
announced  to  the  Socie'te'  de  Biologie  (in  October  and  November, 
1852),  that  he  had  seen  galvanization  of  the  sympathetic  nerve 
diminish  the  quantity  of  the  blood  and  the  temperature,  &c.2  In 
February,  1853,  a  very  able  English  physiologist,  Dr.  Augustus 
Waller,  being  unaware  of  what  I  had  published,  and  of  the  more 
recent  paper  of  Prof.  Bernard,  announced  to  the  Academy  of 
Sciences  of  Paris,3  that  he  had  found  the  galvanization  of  the 
sympathetic  nerve  producing  effects  opposite  to  those  of  its  sec- 
tion ;  and  he  gave  the  same  theory  that  I  had  already  proposed — a 
theory  which  has  since  been  admitted  by  almost  all  the  physiolo- 
gists who  have  written  on  this  subject. 

As  I  consider  that  the  knowledge  of  the  effects  of  the  paralysis, 
and  the  irritation  of  the  sympathetic  nerve,  opens  a  new  and  most 
important  field  in  physiology,  in  pathology,  and  in  therapeutics,  I 
will  give  at  length  two  lists  of  the  phenomena  which  have  been 
observed  after  the  section  and  after  the  galvanization  of  the  cervi- 
cal sympathetic  nerve. 

I.  Effects  of  the  Section  of  the  Cervical  Sympathetic  Nerve. 

Phenomena  observed  in  the  head,  on  the  side  of  the  Authors  who  have  made 
operation.  the  first  observation. 

1.  Constriction  of  the  pupil  ....  Pourfour  du  Petit. 

2.  The  eye  seems  to  he  smaller,  or  even  truly  shrinks    .  Idem. 

3.  The  eye  is  drawn  hack-wards  and  a  little  inwards       .  Idem. 

4.  The  eyelids  are  partially  closed  .  .  .  Idem. 


1  Philadelphia  Medical  Examiner,  August,  1852,  p.  4S9.  This  paper  has  "been 
reprinted  in  my  -work,  "  Exper.  Researches  applied  to  Physiol,  and  Pathol."  p.  9. 
New  York,  1853. 

2  Comptes  rendus  de  la  Soc.  de  Biol.,  in  Gaz.  Med.,  1852,  p.  775  ;  and  1853,  p.  71. 

3  Comptes  rendus  de  l'Acad.  des  Sciences,  seance  du  28  Fevrier,  1853. — I  will, 
by  and  by,  point  out  what  had  already  been  done  as  regards  the  influence  of 
nerves  on  bloodvessels,  by  Stilling,  Henle,  Mr.  James  Paget,  and  Mr.  Wharton 
Jones,  before  the  researches  of  Prof.  Bernard. 


SECTION    OF    CERVICAL    SYMPATHETIC    NERVE. 


141 


Phenomena  observed  in  the  head,  on  the  side  of  the 
operation. 

5.  The   third  eyelid,  or  nictjtant   membrane,  advances 

upon  the  globe  of  the  eye,  and  sometimes  extends 
over  a  part  of  the  cornea.    .... 

6.  The  production  of  the  palpebral  mucus  is  increased  . 

7.  The  cornea  becomes  natter  and  dimmer 

8.  Almost  all  the  muscles  of  the  eye  are  contracted 

9.  The  muscles  of  the  angle  of  the  mouth  and  of  the 

nostril  are  contracted  .... 

10.  The  ear  is  kept  erect,  partly  on  account  of  the  con- 

traction of  some  of  its  muscles 

11.  There  is  an  evident  increase  in  the  quantity  of  blood 

12.  The  temperature  is  notably  increased 

13.  Sensibility  is  increased  .... 

14.  When  the  animal  is  killed,  the  reflex  faculty  lasts 

longer  there  than  in  the  other  side 

15.  Voluntary  movements  seem  also  to  last  loDger. 

16.  Sensibility  also  lasts  longer      .... 

17.  The  reflex  movements  of  the  iris  last  longer  . 

18.  The  sense  of  hearing  seems  to  be  more  acute  . 

19.  The  sensibility  of  the  retina  seems  to  be  increased 

20.  Perspiration  (particularly  from  the  ears  in  horses),  is 

increased      ...... 

21.  The  secretion  of  cerumen  is  increased 

22.  The  secretion  of  tears  is  increased 

23.  Absorption  is  more  rapid  .... 

24.  Chloroform  destroys  sensibility  there  later  than  else- 

where ...... 

25.  The  color  of  venous  blood  is  changed 

26.  The  quantity  of  fat  diminishes  (?) 

27.  The  first  convulsions,  after  poisoning  by  strychnia, 

take  place  there        ..... 

28.  A  galvanic  current,  too  weak  to  act  on  the  other  side, 

may  produce  contractions  there 

29.  The  so-called  recurrent  sensibility  of  the  facial  nerve 

is  increased  ...... 

30.  The  pressure  of  blood  on  the  walls  of  the  arteries  is 

increased       ...... 

31.  After  death  the  motor  nerves  of  the  face  seem  to  re- 

main excitable  longer  than  on  the  other  side 

32.  The  muscles,  also,  and  the  iris  remain  contractile 

longer  ...... 

33.  The  irritability  of  the  arteries,  and  particularly  of  the 

principal  auricular,  is  increased,  at  least  for  several 
weeks  after  the  operation,  and  it  lasts  longer  after 
death  ...... 

34.  Cadaveric  rigidity  comes  later,  and  lasts  longer 

35.  Putrefaction  comes  later  .... 

36.  The  galvanic  current  of  the  muscles,  detected  with 

the  galvanoscopic  frog,  is  stronger  than  in  those  of 
the  other  side  ..... 


Authors  who  have  made 
the  first  observation. 


Pourfour  du  Petit. 

Idem. 

Idem. 

Bernard. 

Idem. 

Brown-Sequard. 
Dupuy  and  Bernard. 
Idem. 
Bernard. 

Idem. 

Brown-Sequard. 

Idem. 

Idem. 

Idem. 

Idem. 

Dupuy. 
Schiff. 

(?) 
Bernard. 

Idem. 

Martini  and  Bernard. 

Martini. 

Brown-Sequard. 

Idem. 

Idem. 

Bernard. 

Brown-Sequard. 

Idem. 


Idem. 
Idem. 
Idem. 


Idem. 


142 


THE    CENTRAL    NERVOUS    SYSTEM. 


Phenomena  observed  in  the  head  on  the  side  of  the 
operation. 

37.  Injections  of  red  blood  by  the  carotid  and  vertebral 

arteries,  after  death.,  are  able  to  regenerate  the  vital 
properties  of  the  nervous  and  of  the  contractile  tis- 
sues, later  there  than  on  the  other  side 

38.  Various  pathological  alterations  may  take  place,  \ 

chiefly  in  the  eye  j 


Authors  who  have  made 
the  first  observation. 


Brown-Sequard. 
Petit,  Molinelli,  Mayer, 
J.  Reid,  &c. 


I  pass  now  to  the  list  of  phenomena  observed  after  the  gal  van 
ization  of  the  cervical  sympathetic. 


Phenomena  observed. 

1.  Dilatation  of  the  pupil  .... 

2.  The  eyelids  are  wide  opened,  and  the  globe  of  the  eye 

protrudes      ...... 

3.  The  bloodvessels  contract,  and  the  quantity  of  blood 

diminishes    ...... 

4.  The  temperature  diminishes    .... 

5.  Sensibility  diminishes  .... 

6.  The  conjunctiva  and  the  cornea  become  dry  . 

7.  Strychnia  produces  less  convulsions  there  than  on  the 

other  side     ...... 

8.  After  death,  the  vital  properties  of  the  motor  and  sen- 

sitive nerves  disappear  there  sooner  than  on  the 
other  side      ...... 

9.  The  irritability  of  the  iris  and  of  the  muscles  disap- 

pears also  sooner  after  death 

10.  The  contractility  of  the  arteries  lasts  less  time  after 

death  ...... 

11.  The  galvanic  current  given  by  the  muscle3  is  very 

weak  .  .  . 

12.  Cadaveric  rigidity  comes  sooner,  and  lasts  less  time  . 

13.  Putrefaction  comes  sooner        .... 

14.  The  faculty  of  regeneration  of  the  vital  properties  in 

the  muscles  of  the  face  after  cadaveric  rigidity  has 
appeared,  is  lost  sooner  than  on  the  other  side 


Discoverers. 
Aug.  Waller  &  Budge. 

Bernard. 

Brown-Sequard. 

Idem. 

Idem. 

Idem. 

Idem. 


Idem. 

Idem. 

Idem. 

Idem. 
Idem. 
Idem. 


Idem. 


It  is  evident  that  all  these  phenomena  are  just  the  reverse  of 
those  which  follow  the  section  of  the  cervical  sympathetic. 

The  phenomena  observed  after  the  section  or  the  galvanization 
of  this  nerve,  with  the  exception  of  a  few,  may  be  summed  up 
under  the  three  following  heads: — 

Section  of  the  Nerve. 

1.  Dilatation  of  Bloodvessels. 

2.  Afflux  of  Blood. 

3.  Increase  of  Vital  Properties. 


Galvanization  of  the  Nerve. 

1.  Contraction  of  Bloodvessels. 

2.  Diminution  of  Blood. 

3.  Decrease  of  Vital  Properties. 


The  view,  that  the  section  of  the  cervical  sympathetic  is  followed 
by  a  paralysis  of  the  bloodvessels,  in  consequence  of  which  more 


SECTION    OF    CERVICAL    SYMPATHETIC    NERVE.  143 

blood  passes  through  these  vessels  in  a  given  time,  producing  the 
increase  of  the  vital  properties  of  the  contractile  and  nervous  tis- 
sues— this  view-  is  now  admitted  by  almost  all  physiologists.  It  is 
based  on  a  great  many  various  experiments  made  by  Dr.  Aug. 
Waller,  Donders,  and  several  of  his  pupils,  Kussmaul,  and  Tenner, 
Moritz,  Schiff,  and  myself,  showing  that  all  the  circumstances, 
whatever  they  may  be,  which  cause  an  increase  in  the  quantity  of 
blood  passing  in  the  bloodvessels  of  the  head  in  a  given  time,  pro- 
duce there  almost  all,  if  not  all,  the  phenomena  following  the  sec- 
tion of  the  cervical  sympathetic.  The  hanging  down  of  an  animal, 
by  holding  it  by  its  hind-legs,  in  producing  a  congestion  in  the 
head,  produces  very  nearly  all  the  effects  of  this  section.1 

We  regret  very  much  not  having  time  to  relate  the  most  decisive 
proofs  of  the  view  that  we  hold.  Many  of  these  facts  not  only 
prove  the  correctness  of  our  view,  but  they  show  the  untenability 
of  a  vitalistic  theory,  according  to  which  the  normal  actions  of  the 
sympathetic  nerve  would  be  increased  after  it  has  been  divided,  and 
diminished  when  it  is  excited  by  galvanism,  and  according  to 
which,  also,  nutrition  and  animal  heat  would  be  dependent  upon 
the  sympathetic  nerve,  which  would  produce  an  increase  of  these 
two  functions  after  it  has  been  divided  (although  it  then  ought  to 
cease  to  act),  and  a  diminution  of  these  functions  when  it  is  galva- 
nized (although  it  then  ought  to  act  more  than  normally). 

However,  we  are  ready  to  acknowledge  that  there  are  other 
causes  of  active  circulation  in  the  head,  after  the  section  of  the  cer- 
vical sympathetic,  besides  the  paralysis  of  the  bloodvessels.  The 
very  fact  that  there  is  more  blood  producing  an  increase  in  nutri- 
tion and  secretion — a  fact  which  depends  chiefly,  as  we-  have  said, 
upon  the  paralysis  of  bloodvessels,  produces  an  increase  in  the 
normal  suction-power  of  the  capillaries.  In  other  words,  the  greater 
afflux  of  arterial  blood  is  itself,  through  the  increased  chemical 
changes  of  nutrition  and  secretion,  a  cause  of  attraction  of  arterial 
blood.2     To  this  cause  another  one  of  the  same  kind  ought  to  be 

1  See  my  paper,  "  Sur  les  Effets  de  la  Section  et  de  la  Galvanization  du  Grand 
Sympathique.     Paris,  1854. 

2  For  the  demonstration  of  the  normal  attraction  of  arterial  blood  by  the  living 
tissues,  and  of  the  participation  of  capillaries  in  the  causes  of  the  circulation  of 
blood,  I  will  refer  to  the  learned  treatises  on  Human  and  Comparative  Physiology 
of  Prof.  Carpenter ;  to  the  original  works  of  Professor  Draper,  of  New  York ;  and, 
especially  to  a  most  able  and  complete  treatise  on  the  subject — although  modestly 
published  as  a  review — by  Mr.  W.  S.  Savory.  {Brit,  and  For.  Med.-Chir.  Rev., 
April  and  July,  1855.) 


144  THE    CENTRAL    NERVOUS    SYSTEM. 

added:  it  is,  that  as  there  is  more  blood,  the  temperature  is  in- 
creased, and  as  the  temperature  is  augmented,  the  chemical  changes, 
which  are  a  cause  of  attraction  of  blood,  are  also  augmented. 
From  this  statement  it  may  be  concluded  that  the  primitive,  and,  I 
may  say,  by  far  the  principal,  cause  of  augmentation  in  the  afflux 
of  blood,  is  the  absence  of  contraction  of  the  bloodvessels,  which 
allows  this  liquid  to  pass  easier  there  than  elsewhere. 

We  now  come  to  the  question,  What  is  the  origin  of  the  cervical 
sympathetic  nerve?  That  most  ingenious  physiologist,  Dr.  Augus- 
tus Waller,  has  made  experiments,  with  Prof.  J.  Budge,  which  seem 
to  prove  that  the  nerve-fibres  of  the  cervical  sympathetic  that  go 
to  the  iris  originate  from  the  spinal  cord,  between  the  sixth  cervical 
and  the  fourth  dorsal  vertebrae.  We  have  ascertained  that  the 
origins  of  the  fibres  of  the  sympathetic  going  to  the  iris  are  more 
extended  than  they  thought.  A  section  of  a  lateral  half  of  the 
spinal  cord  at  the  level  of  the  fifth,  the  sixth,  and  even  sometimes 
as  low  clown  as  the  ninth  or  tenth,  dorsal  vertebra,  affect  the  iris 
like  the  section  of  the  sympathetic,  though  in  a  less  degree.  On 
the  other  hand,  we  have  seen,  as  Schiff  also  has,  that  some  of  the 
fibres  animating  the  iris  ascend  the  cervical  part  of  the  spinal  cord, 
and  most  probably  go  up  to  the  medulla  oblongata. 

As  regards  the  other  fibres  of  the  sympathetic,  those  going  to 
the  bloodvessels  of  the  various  parts  of  the  head,  I  found,  as  early 
as  1852, '  that  they  come  out  chiefly  from  the  spinal  cord,  by  the 
roots  of  the  last  cervical,  and  first  and  second  dorsal  nerves. 
Their  place  of  real  origin  I  think  to  be,  partly  the  spinal  cord, 
partly  the  higher  portions  of  the  encephalon,  but  chiefly  the  me- 
dulla oblongata  and  the  neighboring  parts  of  the  encephalon. 

In  the  other  parts  of  the  body  the  nerves  of  bloodvessels  seem 
to  come  chiefly  from  the  cerebro-spinal  centre,  as  well  as  the  cer- 
vical sympathetic.  If  we  divide  transversely  a  lateral  half  of  the 
spinal  marrow  in  the  dorsal  region,  we  find  in  the  lower  limb  on 
the  same  side  most  of  the  effects  of  a  section  of  the  sympathetic  in 
the  neck.  Amongst  these  effects  we  may  point  out  the  following: 
1st,  dilatation  of  bloodvessels  ;  2d,  greater  afflux  of  blood;  3d,  ele- 
vation of  temperature;  4th,  hyperalgesia;  5th,  increase  of  the 
vital  properties  of  muscles,  and  of  the  motor  nerves.2 

The  following  list  contains  the  most  interesting  features  of  this 
comparison: — 

1  Medical  Examiner,  Philadelphia,  Aug.  1852,  p.  489. 

2  See  Proceedings  of  the  Royal  Society,  vol.  viii.  No.  27,  1857,  p.  594. 


ORIGIN  OF  NERVES  OF  BLOODVESSELS. 


145 


Section  of  the  cervical  sympathetic  nerve ; 
its  effects  on  the  corresponding  side  of 
the  face. 

1.  Bloodvessels  dilated  (paralyzed). 

2.  As  a  consequence,  more  blood. 

3.  Elevation  of  temperature. 

4.  Sensibility  slightly  increased. 

5.  Sensibility  lasting  longer  there  than 
on  the  other  side,  when  the  animal  is 
chloroformized. 

6.  Sensibility  lasting  longer  there  than 
on  the  other  side,  during  agony. 

7.  Many  muscles  contracted. 

8.  Absorption  more  rapid. 

9.  Increase  of  sweat  and  other  secretions. 

10.  Reflex  movements  last  longer  there 
than  elsewhere,  after  death.      .    • 

11.  After  poisoning  by  strychnia,  the 
first  convulsions  take  place. 

12.  A  galvanic  current  too  weak  to  ex- 
cite contraction  elsewhere,  may  act 
there. 

13.  The  motor  nerves  after  death,  re- 
main longer  excitable  there  than  on 
the  other  side. 

14.  The  muscles,  after  death,  remain 
longer  contractile  there  than  on  the 
other  side. 

15.  The  contractility  of  bloodvessels  is 
greater,  and  lasts  longer  there. 

16.  The  galvanic  muscular  current  (as 
ascertained  with  the  rheoscopic  frog), 
is  stronger,  and  lasts  longer  there  than 
on  the  other  side. 

17.  Cadaveric  rigidity  appears  later 
there  than  on  the  other  side,  and  it 
lasts  longer. 

18.  It  is  easier  to  regenerate  there  than 
on  the  other  side,  the  vital  properties 
of  nerves  and  muscles  by  injections  of 
red  blood,  a  short  time  after  they  have 
disappeared. 

19.  Putrefaction  comes  on  later,  and 
seems  to  progress  more  slowly  there 
than  on  the  other  side. 


Section  of  a  lateral  half  of  the  spinal  cord 
in  the  dorsal  region ;  its  effects  on  the 
posterior  limb  on  the  corresponding  side. 

1.  The  same  effect. 

2.  The  same  effect. 

3.  The  same  effect. 

4.  Very  much  increased. 

5.  Lasting  longer  than  anywhere  else, 
during  chloroformization. 

6.  Lasting  longer  than  anywhere  else 
during  agony. 

7.  A  state  of  slight  contraction  in  many 
muscles. 

8.  The  same  effect. 

9.  Increase  of  sweat. 

10.  The  same  effect. 

11.  The  same  effect. 

12.  The  same  effect. 


13.  The  motor  nerves,  after  death,  re- 
main notably  longer  excitable  there. 

14.  The   muscles    after    death    remain 
much  longer  contractile  there. 

15.  The  same  effect. 

16.  The  same  effect  (more  marked). 


17.  Cadaveric  rigidity  appears  notably 
later  there  than  elsewhere,  and  lasts 
longer. 

18.  The  same  effect  (more  marked). 


19.  The  same  effect  (more  marked). 


The  question  concerning  the  real  origin  of  the  nerves  of  blood- 
vessels in  the  cerebro-spinal  centres  is  not  yet  entirely  solved,  but 

K 


146  THE    CENTRAL    NERVOUS    SYSTEM. 

many  points  are  already  established.  I  will  postpone,  however,  all 
that  I  have  still  to  say  on  this  subject  till  I  treat  of  the  share  these 
nerves  take  in  certain  pathological  conditions. 

We  have  already  said  what  are  the  effects  of  the  galvanization 
of  the  cervical  sympathetic  nerve.  We  will  add  only  a  few  re- 
marks to  our  previous  statements.  The  motor  nerve-fibres  of  the 
sympathetic  which  go  to  bloodvessels  (the  vasomotor  nerve-fibres), 
are  able  to  act  when  directly  excited;  but  there  does  not  lie  the 
principal  feature  of  their  physiological  history;  they  are  also  able 
to  produce  the  contraction  of  the  bloodvessels  by  a  reflex  action. 
The  first  fact  in  science  which  established  positively  that  such  a 
phenomenon  is  possible,  was  observed  by  my  friend  Dr.  Tholozan, 
and  myself.  We  found  that  the  bloodvessels  of  one  hand  contract 
very  much  when  the  other  hand  is  dipped  into  water  at  a  very 
low  temperature  (from  32°  to  34°  Fahr.).  The  more  pain  we  felt 
from  the  influence  of  the  cold  water,  the  more  and  the  sooner  did 
the  bloodvessels  of  the  hand  left  out  of  the  water  contract.1  Since 
the  time  we  published  these  facts,  several  physiologists  have  found 
that  the  bloodvessels  of  the  ear,  which  receive  their  motor  nerve-' 
fibres  from  the  cervical  sympathetic,  contract  when  the  cutaneous 
branches  of  some  of  the  spinal  nerves  are  excited.  Various  deci- 
sive experiments  have  proved  that  this  contraction  takes  place  by 
a  reflex  action.  When  we  treat  of  epilepsy,  we  will  show  that  one 
of  the  principal  features  of  a  fit  depends  upon  a  reflex  contraction 
(through  the  sympathetic),  of  the  bloodvessels  of  the  brain  proper. 

The  bloodvessels,  like  muscles  of  animal  life,  may  have  spasms, 
as  well  as  they  may  be  paralyzed.  In  certain  injuries  to  the 
nervous  centres  there  are  spasms  produced  in  the  bloodvessels  of 
many  parts  of  one-half  of  the  body,  at  the  same  time  that  there 
are  paralysis  and  dilatation  of  those  of  the  other  half  of  the  body. 
A  section  of  a  lateral  half  of  the  spinal  cord  near  the  medulla 
oblongata  produces  this  curious  effect;  on  the  side  injured,  the 
bloodvessels  of  the  extremities  are  paralyzed;  while  on  the  oppo- 
site side  they  are  spasmodically  contracted.  Very  often  the  spasm 
persists  for  days,  and  after  temporary  relaxations  it  alternately  re- 
appears and  disappears  again. 

The  spasm  of  bloodvessels  may  be  so  great  that  circulation  is 
almost  entirely  suspended;  the  temperature  of  the  limbs  (especially 

1  See  my  Experimental  Researches  on  Physiology  and  Pathology,  1853,  p.  32, 
and  Journal  de  la  Physiologie  de  l'Homme,  etc.,  Paris,  Juillet,  185S.  p.  497. 


SPASM  OF  BLOODVESSELS.  147 

that  of  the  toes)  falls  quicker  than  after  death,  and  it  is  soon  at 
nearly  the  same  degree  as  that  of  the  atmosphere.  In  one  case,  in 
a  dog,  we  have  seen  the  temperature  of  the  toes  on  the  left  side, 
after  the  section  of  the  right  half  of  the  cord  in  the  cervical  region, 
falling  from  26°  Centigrade  (78.8°  Fahr.)  to  15J°  (59.9°  Fahr.),  the 
atmosphere  being  at  15°  (59°  Fahr.).  In  the  toes,  on  the  right 
side,  the  temperature  had  increased  extremely,  and  reached  36° 
Cent.  (96.8°  Fahr.). 

If  we  have  time,  we  will  try  to  show,  in  another  lecture,  that 
this  spasm  of  bloodvessels  is  the  cause  of  the  coldness  of  the  feet 
and  hands  in  epileptics  and  certain  paralytics:  it  is  a  result  of  an 
irritation  of  the  cerebro-spinal  axis,  and  chiefly  of  the  upper  parts 
of  the  spinal  cord  and  of  the  medulla  oblongata.  We  will  also  try 
to  show  the  share  of  this  spasm  in  the  cold  stage  in  intermittent 
fever,  in  cholera,  or  after  the  introduction  of  a  catheter  in  the 
urethra,  &c. 

In  the  posterior  limb  of  a  dog,  in  which  the  bloodvessels  are  in 
a  state  of  spasm,  the  circulation  is  so  much  impeded,  that  the  cut- 
ting of  the  skin  hardly  gives  a  drop  of  blood.  As  this  state  exists 
in  cases  of  a  section  of  a  lateral' half  of  the  spinal  cord,  near  the 
encephalon,  and  as  the  other  posterior  limb  has  then  its  blood- 
vessels paralyzed,  and,  therefore,  dilated,  it  might  be  supposed  that 
the  diminution  in  the  amount  of  blood  in  one  limb  depends  on  the 
increase  of  its  amount  in  the  other.  Let  us  imagine,  for  instance, 
that  the  right  lateral  half  of  the  spinal  cord  has  been  divided;  the 
bloodvessels  of  the  posterior  limb,  as,  also,  those  of  other  parts 
on  the  same  side,  are  paralyzed,  and,  therefore,  they  do  not  oppose 
any  resistance  to  the  causes  of  the  circulation  of  the  blood,  while 
the  left  posterior  limb  continues  to  have  its  bloodvessels  resisting 
to  these  causes.  I  suppose  that  the  amount  of  blood  passing  in 
the  aorta,  where  it  divides  into  the  two  common  iliac  arteries,  is, 
in  a  given  time,  twenty  ounces,  ten  for  each  of  the  posterior  limbs, 
and  that,  after  the  operation  (the  aorta  continuing  to  give  the  same 
amount  of  blood),  sixteen  ounces,  instead  of  ten,  pass  in  the  right 
common  iliac,  on  account  of  the  paralyzed  state  of  its  branches, 
and  of  their  ramifications.  The  result  of  such  a  change  ought  to 
be,  that  only  four  ounces  will  pass  in  the  left  common  iliac.  Sup- 
posing this  to  be  the  case,  the  diminution  of  circulation  in  the  left 
limb  might  be  explained,  without  our  admitting  the  existence  of  a 
spasm  of  bloodvessels.  But  it  is  not  on  the  simple  fact  that  circu- 
lation is  diminished,  that  I  ground  the  opinion  that  there  is  a 


.US  THE    CENTRAL    NERVOUS    SYSTEM. 

spasm :  it  is  on  the  result  of  direct  experiments,  the  detail  of  which 
I  have  not  time  to  describe,  but  of  which  some  show — 1st,  that  if 
a  ligature  be  put  round  the  right  iliac  artery  in  a  dog  operated 
upon  as  we  have  already  stated,  the  temperature  rises  but  little, 
and  slowly,  in  the  extremity  of  the  left  limb,  although  almost  the 
whole  of  the  blood  coming  from  the  aorta  passes  into  the  left  iliac, 
and  it  is  quite  evident  that  the  small  arteries,  at  least  near  the  toes, 
do  not  allow  the  blood  to  pass  freely;  2d,  that  an  injection  of 
blood  by  the  femoral  artery  is  difficult  to  be  made  in  the  left  limb, 
compared  to  limbs  of  healthy  dogs. 

In  those  cases  of  gangrene  in  which  no  obstruction  has  been 
found  after  death  in  the  vessels  of  the  dead  parts,  it  is  extremely 
probable  that  a  long-persistent  spasm  of  the  bloodvessels  has 
existed,  rather  than  simply  a  cessation  of  the  attraction  of  blood, 
according  to  the  explanation  of  Dr.  Houston.1 

Now,  to  sum  up  all  that  we  have  stated  about  the  sympathetic 
nerve,  we  will  say — first,  that  it  is  essentially  (though  not  exclu- 
sively) a  motor  nerve  of  bloodvessels ;  secondly,  that  it  originates 
chiefly  from  the  cerebro-spinal  axis ;  thirdly,  that  its  paralysis  is 
characterized  by  a  dilatation  of  bloodvessels  and  an  afflux  of  blood, 
with  the  results  of  this  afflux;  fourthly,  that  its  excitation,  direct 
or  reflex,  is  characterized  by  a  contraction  of  bloodvessels,  and  the 
results  of  this  contraction. 

The  question  now  comes :  Can  we  explain  all  the  phenomena, 
normal  and  pathologic,  showing  the  direct  or  the  reflex  influence 
of  the  nervous  system  on  nutrition  and  secretion,  by  the  above 
notions  concerning  the  effects  of  paralysis  or  excitation  of  the 
sympathetic  nerve  on  bloodvessels  ?  For  several  years  I  have  felt 
inclined  to  admit  the  possibility  of  an  explanation  of  these  pheno- 
mena founded  only  upon  these  notions,  but  I  must  say,  that  facts 
discovered  by  Ludwig,  by  Czermak,  and,  especially,  by  Professor 
Bernard,  seem  to  have  solved  the  question  in  the  most  positive 
manner,  and  that  it  seems  absolutely  certain  that  there  is  some 
agency  of  the  nervous  system  which  is  not  simply  an  influence  on 
the  constricting  muscular  fibres  of  the  bloodvessels,  in  the  normal 
or  pathological  phenomena  of  nutrition  and  secretion.  I  must  add, 
also,  that  the  views  held,  in  this  respect,  by  the  most  eminent 
British  physiologists  (Mr.  J.  Paget,  Dr.  Carpenter,  Dr.  Todd,  and 

1  See  his  interesting  remarks  on  a  case  of  Mortification  after  Fever,  in  the  Dub- 
lin Medical  Journal,  1836,  pp.  217-219. 


INFLUENCE  ON  NUTKITION  AND  SECEETION.  149 

others)  have,  by  the  discovery  of  the  facts  I  allude  to,  received  a 
sanction  which,  I  confess,  they  needed.  The  principal  amongst 
these  facts  is  the  following:  Instead  of  contracting,  the  blood- 
vessels of  the  salivary  glands  become  enlarged,  when  certain 
nerves  are  excited.1  I  think  that  this  enlargement  in  the  blood- 
vessels must  be  due  to  a  greater  attraction  of  the  arterial  blood  by 
the  tissue  of  the  gland;  and  we  explain  this  increased  attraction 
by  the  production  of  the  chemical  interchanges  between  the  secre- 
tory tissue  and  the  blood,  which  are  rendered  manifest  by  the 
secretion  of  saliva,  then  taking  place. 

The  researches  of  Czermak  and  of  Professor  Bernard  tend  to 
show  that  the  increase  in  the  salivary  secretion  does  not  depend 
on  the  sympathetic  nerve,  but  on  the  lingual ;  and  we  have  now, 
in  this  discovery,  the  explanation  of  the  following  apparent  con- 
tradiction :  how  can  it  be  that  the  glands  of  the  eye,  of  the  ear, 
&c.,  secrete  more  when  their  bloodvessels  are  paralyzed  and  en- 
larged after  the  section  of  the  sympathetic  nerve,  and  that  an 
increase  in  the  secretion  of  the  salivary  and  other  glands  is  due  to 
a  nervous  excitation  ?  How  can  it  be  that,  in  one  case,  secretion 
is  increased  when  the  bloodvessels  are  dilated,  and  that,  in  other 
cases,  it  would  be  increased  while  their  vessels  ought  (according 
to  what  we  thought)  to  be  contracted  ?  This  contradiction  dis- 
appears now  that  Bernard  shows  that,  instead  of  being  contracted, 
the  bloodvessels  are  dilated  in  these  last  cases.  Besides,  the  experi- 
ments of  Czermak  and  Bernard  show  that  the  salivary  secretion  is 
arrested  when  the  sympathetic  nerve  is  excited ;  and  we  know 
that  this  nerve,  when  excited,  has  the  same  stopping  influence  on 
the  lachrymal  and  on  the  mucous  glands  of  the  eye  and  ear,  &o. 

From  this  discussion  we  conclude  that  there  are  two  kinds,  at 
least,  of  immediate  influences  of  the  nervous  system,  either  by  a 
direct  or  by  a  reflex  action,  on  nutrition  and  secretion,  normal  or 
pathologic.  By  one,  which  we  see  plainly  when  the  cervical  sym- 
pathetic nerve  is  excited,  the  bloodvessels  contract,  and  there  is  a 
diminution  of  secretion  and  nutrition ;  by  the  other,  the  discovery 
of  which  is  chiefly  due  to  Prof.  Bernard,  the  bloodvessels  dilate  in 
consequence  of  a  greater  attraction  for  arterial  blood  developed  in 
the  tissues-2    Which  of  these  two  modes  of  action  is  the  most  fre- 

1  This  had  been  found  by  Professor  Bernard.  See  the  Journal  de  la  Physiol, 
de  l'Homme,  &c,  April,  1858,  p.  240,  and  especially  October,  1858,  pp.  646-665. 

2  Recently,  Professor  Bernard  has  considered  this  dilatation  as  an  active  phe- 
nomenon ;  and  he  has  imagined  that  the  capillaries  have  two  properties,  one  of 


150  THE    CENTRAL    NERVOUS    SYSTEM. 

quent?  and  which  is  the  most  powerful  in  producing  the  normal 
and  the  morbid  phenomena  of  nutrition  and  secretion  ?  These  are 
questions  very  difficult  to  be  solved.  If  we  have  time,  however, 
we  will,  in  our  next  lecture,  mention  facts  throwing  some  light 
upon  them. 

contraction  and  the  other  of  dilatation  ;  and  that  the  first  of  these  properties  is  put 
in  play  by  one  set  of  nerves,  and  the  other  by  another  set.  We  have  no  doubt 
that  he  will  soon  abandon  these  hypothetic  and  untenable  views.  (See  Journal  de 
Physiol,  pp.  646-665.) 


151 


LECTURE  X. 

ON  THE  INFLUENCE  OF  THE  NERVOUS  SYSTEM  UPON  NUTRITION  AND 
SECRETION;  WITH  REMARKS  ON  THE  IMPORTANCE  OF  THE  KNOW- 
LEDGE OF  THIS  INFLUENCE  FOR  THE  TREATMENT  AND  THE  EXPLA- 
NATION OF  THE  PRODUCTION  OF  MANY  DISEASES. 

Distinction  between  the  effects  of  the  excitation  of  the  nervous  system  and  those 
of  the  absence  of  action  of  this  system. — Three  kinds  of  reflex  actions :  contrac- 
tion, secretion,  and  modification  of  nutrition. — Normal  and  morbid  reflex  secre- 
tions.— Normal  and  morbid  reflex  changes  in  nutrition. — Reflex  influence  of 
injuries  of  the  trigeminal  nerve  upon  the  eye. — Reflex  influence  of  one  eye  upon 
the  nutrition  of  the  other. — Sudden  arrest  of  the  heart's  movements  by  a  reflex 
action. — Cause  of  the  rapid  death  after  injuries  of  the  abdominal  sympathetic 
nerve. — Stoppage  of  the  heart's  movements  by  the  application  of  cold  to  the  skin, 
by  the  influence  of  cold  drinks,  and  in  some  cases  of  death  by  chloroform. — 
Reflex  influence  of  burns  on  the  principal  viscera. — Inflammation  of  the  eyes,  of 
the  testicles,  of  the  nervous  centres,  &c,  by  a  reflex  action. — Muscular  atrophy 
due  to  an  irritation  of  sensitive  nerves. — Paralysis  and  ansesthesia  due  to  a  reflex 
action. — Disturbance  of  the  functions  of  the  brain  and  of  the  senses  produced  by 
irritation  of  centripetal  nerves. — Other  instances  of  reflex  changes  of  nutrition. — 
Mode  of  production  of  the  secretory  and  nutritive  reflex  actions. — Importance  of 
the  knowledge  of  the  reflex  secretory  and  nutritive  phenomena  for  the  treatment 
of  disease. — Influence  of  the  irritation  of  the  nervous  centres  and  of  the  centri- 
fugal nerves  on  nutrition  and  secretion. — Influence  of  the  absence  of  nervous 
action  on  nutrition,  repair  and  secretion. 

Mr.  President  and  Gentlemen:  To  understand  fully  the  mode 
of  influence  of  the  nervous  system,  in  health  and  disease,  upon 
nutrition,  secretion,  and  animal  heat,  it  is  necessary  to  distinguish 
clearly  the  effects  due  to  this  influence  from  those  due  to  its  absence. 
Although  these  two  kinds  of  effects  are  very  different  one  from  the 
other,  they  have  very  often  been  confounded.  For  instance,  it 
might  be  easily  shown  that  many  of  the  best  writers  on  physiology 
and  pathology,  when  trying  to  prove  that  an  influence  of  the  nerv- 
ous system  is  necessary  to  nutrition  and  secretion,  bring  forward 
facts  showing  the  effects  of  excitation  of  the  nervous  system, 
together  with  facts  depending  upon  the  absence  of  action  of  this 
system. 


152  THE    CENTRAL    NERVOUS    SYSTEM. 

The  influence  of  the  nervous  system  on  organic  functions  cannot 
be  proved  to  be  necessary  by  facts  showing  only  that  this  system 
can  act  upon  these  functions.  There  is  no  question  at  all  that  the 
nervous  centres  and  most  of  the  nerves,  directly,  or  by  a  reflex 
action,  can  produce  the  greatest  and  the  most  varied  effects  on 
nutrition  and  secretions;  but  this  power  of  acting  of  the  nervous 
system  does  not  and  cannot  show  that  these  organic  functions  re- 
quire for  their  normal  existence  a  peculiar  influence  of  the  nervous 
organs.  The  only  facts  that  can  prove  positively  that  a  nervous 
influence  is  necessary  to  the  organic  functions,  are  to  be  found  in 
the  effects  of  the  absence  of  any  influence  of  the  nervous  system. 
We  will,  by  and  by,  examine  this  kind  of  effects;  at  present,  we 
propose  to  study  the  effects  of  excitation  of  the  nervous  system 
upon  those  functions. 

The  influence  of  the  nervous  system  on  the  organic  functions  as 
well  as  upon  contractile  tissues,  may  take  place  in  consequence  of 
irritations  on  centrifugal  nerve-fibres,  on  nervous  centres,  or  on 
centripetal  or  sensitive  nerve-fibres.  We  will  first  study  the  effects 
of  the  irritation  of  the  centripetal  nerve-fibres.  It  is  well  known 
that  three  kinds  of  reflex  phenomena  may  be  due  to  such  an  irrita- 
tion :  1st,  a  contraction  of  muscles  or  of  any  kind  of  contractile 
element;  2d,  a  secretion;  3d,  a  change  in  the  nutrition  of  some  part 
of  the  body.1  These  three  kinds  of  reflex  actions  are  represented 
in  Fig.  23. 

1  A  short  time  before  his  death,  Dr.  Marshall  Hall  {The  Lancet,  1857,  vol.  i.  pp. 
4  and  108)  announced,  as  a  new  discovery,  the  supposed  existence  of  a  system  of 
excito-secretory  and  secretory  nerves.  Dr.  H.  F.  Campbell,  of  Georgia  (U.  S.),  has 
claimed  the  priority  of  this  discovery,  which  Dr.  Hall  has,  in  a  great  measure, 
candidly  conceded  to  him  {ibid.,  pp.  462-464).  We  will  merely  remark  here,  that 
Dr.  Campbell  seems  really  to  have  been  the  first  to  introduce  in  science  the  hypo- 
thesis that  there  exists  a  secretory  and  excito-secretory  system  of  nerves,  but  that 
neither  he  nor  Dr.  Hall  has  adduced  a  single  fact  to  prove  the  existence  of  this 
pretended  independent  or  distinct  system  of  nerves.  Both  these  physiologists  seem 
not  to  have  been  aware  that  reflex  secretions  and  reflex  changes  in  nutrition  were 
perfectly  known,  and  that  the  question  was,  not  to  prove  that  there  are  such  reflex 
phenomena,  but  whether  they  are  to  be  explained  by  a  reflex  influence  on  blood- 
vessels or  otherwise.  Any  one  desirous  to  know  the  state  of  science,  in  this  re- 
spect, before  the  first  publication  of  Dr.  Campbell,  will  find,  easily,  that  it  was 
more  advanced  than  in  the  last  paper  of  this  able  physiologist,  in  Mueller's  Manual 
of  Physiology  (2d  German  edition,  1837),  in  Stilling's  Treatise  on  Spinal  Irritation 
(1840),  and  in  several  works  of  Henle  published  in  1840  and  1841.  Since  that 
time  there  has  been  no  treatise  on  Physiology  or  General  Pathology,  and  no  paper 
nor  other  work  on  Inflammation,  that  does  not  speak  of  reflex  phenomena  of  nutri- 
tion or  secretion  as  of  something  well  known.     However,  we  are  pleased  to  be  able 


INFLUENCE  ON  NUTRITION  AND  SECRETION.  153 

The  first  decisive  experimental  proofs  that  secretions  may  take 
place  by  a  reflex  action  have  been  given  by  Ludwig,1  Colin,2  Czer- 
mak,  and  Prof.  Bernard  for  the  salivary  secretion,  and  by  this  last 
physiologist  for  the  secretion  of  sugar  in  the  liver. 

The  laws  of  reflex  secretions  seem  to  be  the  same  as  those  of 
reflex  movements :  1st,  the  peripheric  ramification  of  centripetal 
nerves  has  much  more  power  than  their  trunks  for  the  production 
of  a  reflex  secretion;  2d,  there  are  certain  centripetal  nerves  which 
normally  can  produce  certain  secretions  by  a  reflex  action,  while 
others  cannot;  but  a  morbid  condition  of  a  nerve  or  of  the  nervous 
centres  is  able  to  render  almost  any  nerve  capable  of  producing  any 
secretion ;  3d,  certain  kinds  of  irritation  produce  reflex  secretions 
which  other  kinds  cannot  produce,  except  in  morbid  states. 

These  laws  are  proved  by  many  facts,  some  of  which  I  will  relate 
as  illustrations  of  reflex  secretious.  The  consensus  between  the 
various  digestive  organs  affords  the  most  positive  demonstrations 
of  reflex  secretions.  For  instance,  we  find  saliva  secreted  when 
the  mucous  membrane  of  the  stomach  is  irritated  by  food.  Dr. 
Gairdner3  speaks  of  a  man,  whose  oesophagus  being  divided,  had  a 
secretion  of  from  six  to  eight  ounces  of  saliva  during  a  meal  of 
broth  injected  into  the  stomach.  The  reverse  takes  place  also;  the 
excitation  of  the  nerves  of  taste  produces  an  abundant  reflex  secre- 
tion of  gastric  juice,  and  also  a  flow  of  bile  and  pancreatic  juice  in 
the  bowels.  Several  times  I  have  seen  injections  of  warm  water  in 
the  rectum  of  a  dog,  having  a  gastric  fistula,  producing  a  secretion 
of  gastric  juice.  There  is  some  importance  in  the  knowledge  of 
these  facts ;  for  instance,  guided  by  this  knowledge,  we  can,  if 
necessary,  increase  or  decrease  the  quantity  of  gastric  juice,  in  re- 
commending the  use  of  very  sapid  or  of  nearly  insipid  food,  &c. 

The  morbid  influences  acting  upon  the  digestive  organs  to  pro- 
duce secretions  are  very  well  known.  I  shall  only  point  out  that 
the  curious  effects  of  the  ligature  of  the  oesophagus  (congestions 
and  secretions  in  the  stomach  and  bowels,  efforts  of  vomiting,  &c), 

to  declare  that,  as  if  it  were  impossible  for  Dr.  Marshall  Hall  to  write,  even  on  a 
well-known  subject,  without  putting  upon  it  the  stamp  of  his  inventive  genius,  he 
has  suggested  a  very  important  explanation  of  the  alterations  in  the  mucous  secre- 
tions of  the  lungs  after  a  section  of  the  par  vagum,  in  his  first  paper  on  reflex 
secretions  (loco  cit.,  p.  4). 

1  Zeitschrift  fuer  Rationelle  Medicin,  1851,  N.  P.,  vol.  i.  1851,  p.  260. 

2  Comptes  Rendus  de  l'Acad.  des  Sciences,  1852,  vol.  xxxv.  p.  130. 

3  Edinburgh  Med.  and  Surg.  Journal,  vol.  xvi.  p.  355. 


154:  THE    CENTRAL    NERVOUS    SYSTEM. 

which  have  been  observed  by  Messrs.  Bouley  and  Keynal,1  are 
very  simple  phenomena,  if  we  look  upon  them  as  reflex  actions 
resulting  from  the  irritation  of  the  centripetal  nerve-fibres  of  the 
oesophagus. 

It  is  important  to  know  that  the  gastric  juice  may  be  so  altered 
by  a  reflex  action  due  to  an  irritation  on  the  nerves  of  the  anus  or 
of  the  rectum,  that  digestion  becomes  almost  impossible.  The  late 
Dr.  Chapman,2  of  Philadelphia,  relates  two  cases  of  dyspepsia  (in 
one  of  which  the  gastric  juice  is  said  to  have  been  extremely  corro- 
sive) which  were  cured  almost  immediately  after  the  extirpation  of 
painful  piles.  I  know  a  case  in  which  vomiting  of  a  great  quantity 
of  unduly-acid  gastric  juice  took  place  under  the  irritating  influence 
of  worms  in  the  rectum.  K.  Whytt  says,  that  "the  pain  of  hemor- 
rhoids is,  sometimes,  accompanied  by  a  sickness  of  the  stomach  and 
faintness."   (Observations,  etc.,  p.  26.) 

The  ptyalism  due  to  neuralgia  is  a  good  example  of  morbid  reflex 
secretion.  Dr.  Notta  (Archives  de  Medecine,  Sept.,  1854,  p.  298) 
states  that  ptyalism  has  been  observed  14  times  out  of  128  cases  of 
trifacial  neuralgia. 

Dr.  Cain,  of  Charleston,3  in  a  very  interesting  paper,  in  which  he 
gives  many  instances  of  reflex  disturbances  of  secretion  and  nutri- 
tion, relates  cases  which  seem  to  show  that  croup  may  be  produced 
by  a  reflex  irritation  starting  from  the  stomach.  Facts  of  this  kind 
were  already  known ;  but  here  the  theory  of  the  modus  agendi  of 
the  gastric  irritation  on  the  larynx  is  clearly  exposed  and  based 
upon  many  facts  and  very  sound  reasonings. 

The  production  of  tears  affords  decided  instances  of  reflex  secre- 
tions. We  find  that  any  irritation  of  the  eye,  or  of  the  mucous 
membrane  of  the  nose,  causes  an  increase  in  the  production  of 
tears.  Two  cases  mentioned  by  Henle4  as  having  been  observed, 
one  by  Sir  Charles  Bell,  the  other  by  Vogt,  prove  that  it  is  through 
a  nervous  excitation  that  the  shedding  of  tears  takes  place  when 
we  touch  the  eye.  In  two  patients,  the  eye  having  lost  its  sensi- 
bility, tears  were  no  more  shed  when  this  organ  was  irritated.  Mr. 
Castorani  has  recently  confirmed,  by  decisive  facts,  the  view  that  it 

1  See  the  Report  of  Prof.  Trousseau  to  the  Academy  of  Medicine  of  Paris,  and  my 
remarks  on  this  Report  in  the  Journal  de  Physiol.,  October,  1858. 

2  Lectures  on  the  more  important  Diseases  of  the  Thoracic  and  Abdominal  Vis- 
cera, 1844,  pp.  216-7. 

3  The  Southern  Journal  of  Medicine,  &c,  1847,  p.  377. 

4  Anatomie  Generate,  French  translation,  1843,  vol.  ii.  p.  255. 


KEFLEX  SECKETIONS.  155 

is  not  through  the  optic  nerve  that  the  secretion  of  tears  is  increased 
in  cases  of  photophobia,  when  the  eye  is  exposed  to  the  irritation 
of  light:  it  is  through  the  exalted  excitability  of  the  trigeminal 
nerve.  A  curious  fact  observed  by  Deslandes1  is  in  harmony  with 
this  view:  a  man  totally  blind,  had  an  abundant  secretion  of  tears 
at  every  time  that  he  passed  from  a  dark  place  to  a  lighted  one. 
The  shedding  of  tears  under  the  influence  of  irritation  of  other 
parts  than  the  eye  and  nose  is  less  and  less  the  farther  the  irritation 
is  from  the  eye.  I  have  experimented  upon  myself,  and  found  that 
the  pinching  of  the  neck  or  of  the  back  parts  of  the  head  hardly 
produce  lachrymation,  while  that  of  the  face  produces  it  more  and 
more  the  nearer  to  the  eye  the  irritation  is  made.  This  increased 
secretion  exists  only  on  the  side  irritated,  except  when  the  pinch- 
ing is  made  very  near  the  median  line.  Mr.  Notta2  mentions  that 
lachrymation  has  been  noted  as  an  effect  of  neuralgia  of  the  fifth 
pair  of  nerves  61  times  out  of  128  cases.  It  is  chiefly  in  cases  of 
neuralgia  of  the  supra-orbitary  branch  that  lachrymation  is  pro- 
duced. The  fact  that  the  irritation  of  the  cornea  by  a  foreign  body 
causes  lachrymation,  and  that  the  removal  of  this  irritative  agent  is 
at  once  followed  by  a  cessation  of  this  abundant  and  abnormal 
secretion,  is  a  good  illustration  of  its  mode  of  production. 

If  I  had  time,  I  would  show  that  we  must  admit  that  it  is  by  a 
reflex  action  that  the  following  secretions  take  place  in  the  circum- 
stances that  I  will  point  out:  1.  Secretion  of  milk  by  an  irritation 
of  the  uterus,  of  the  skin  of  the  mammae,  or  of  the  mucous  mem- 
brane of  the  vagina  (particularly  by  the  steam  of  a  decoction  of  the 
jatropha  curcas,  as  done  at  the  Cape  de  Verde  Islands).  2.  Mens- 
truation in  consequence  of  an  irritation  of  the  ovaries  of  the  vagina 
or  of  the  mammas  by  warm  poultices,  &c.  3.  Secretion  of  nasal 
mucus  increased  by  application  of  cold  water  to  the  feet,  and  some- 
times stopped  at  once  by  dipping  of  the  feet  in  iced  water,3  and 
increased  by  a  draught  of  cold  air  on  the  neck.  4.  Secretion  of 
semen  increased  by  the  irritation  of  the  genital  organs.  5.  Perspi- 
ration due  to  neuralgia,  as  in  a  case  by  Dr.  Galliet,  or  due  to  the 
excitation  of  the  nerves  of  taste,  by  salt  or  sugar,  etc.,  as  in  a  case 
I  have  mentioned  to  the  Society  of  Biology,  in  a  communication  on 
reflex  secretions  in  1849.  (See  Cornptes  Rendus  de  la  Soc.  de  Biol., 
vol.  i.  p.  104.) 

1  Dictionn.  de  Med.  et  de  Chir.  Pratiques,  vol.  ii.  p.  179. 

2  Archives  Gener.  de  Medecine,  etc.,  Juillet,  1854. 

3  Hyp.  Cloquet,  These  sur  les  Odeurs,  p.  162. 


156  THE    CENTRAL    NERVOUS    SYSTEM. 

Before  treating  of  the  reflex  changes  in  nutrition,  which  are  by 
far  more  frequent,  and  more  important  to  be  well  investigated,  than 
the  reflex  secretions,  I  must  remark  that  the  reflex  character  of 
facts  more  or  less  similar  to  those  I  have  to  mention  has  been 
known  for  a  long  while,  and  that  the  modern  theory  is  not  far  in 
advance  of  that  given,  in  this  respect,  by  Kobert  Whytt1  in  the  last 
century.  In  one  of  his  important  works  he  has  shown  that  the 
normal  and  morbid  sympathies,  either  for  movements,  nutrition,  or 
secretion,  are  reflex  phenomena.  Still  more,  he  has  shown  that  the 
share  of  bloodvessels  is  very  great  in  many  of  these  phenomena. 

Although  Kobert  Whytt  and  several  other  writers,  amongst 
whom  I  will  name  Tissot,  Prochaska,  Barthez,  J.  Mueller,  Henle, 
and  Prof.  Martyn  Paine,  have  published  so  many  interesting  facts 
concerning  the  sympathy  between  various  parts  of  the  body,  phy- 
siologists and  practitioners  have  not  paid  a  sufficient  attention  to 
this  most  important  subject.  I  regret  that  I  cannot  enter  into  great 
developments  on  the  capital  points  concerning  this  subject;  but  I 
will,  at  least,  endeavor  to  show  their  importance. 

Keflex  changes  in  nutrition  ought  to  be  known  as  being  amongst 
the  most  frequent  causes  of  many  diseases.  An  irritation  starts 
from  an  excitable  part  of  a  nerve,  it  reaches  the  nervous  centres, 
and  thence,  being  reflected  to  a  more  or  less  distant  part  of  the 
body,  it  produces  either  a  contraction  of  a  bloodvessel,  and,  through 
this,  effects  a  diminution  of  nutrition,  or  it  acts  directly  upon  the 
tissues,  and  produces  an  alteration  of  the  interchanges  between  them 
and  the  blood.  The  eye,  amongst  all  the  other  organs  in  the  body, 
is  the  one  that  gives  the  most  evident  and  the  most  frequent  in- 
stances of  this  kind  of  affection.  The  most  positive  of  these  facts, 
as  regards  the  production  by  a  reflex  action,  are  the  following: 
1st.  When  the  supra-orbitalis  nerve  has  been  crushed  or  injured, 
in  such  a  way  that  it  remains  irritated,  an  inflammation  or  some 
other  affection  of  the  corresponding  eye  supervenes,  which  is  cured 
either  by  the  means  that  diminish  the  irritation  of  the  injured 
nerve,  or  by  its  section  between  the  nervous  centre  and  the  injured 
part,  so  as  to  prevent  reflex  actions  starting  from  this  irritated  part. 
2d.  When  an  eye  is  the  seat  of  a  violent  inflammation,  and  particu- 
larly if  it  be  of  traumatic  origin,  it  is  not  rare  for  the  other  eye  to 
become  affected,  and  the  successful  treatment  for  the  affection  of 
this  last  eye  consists  in  preventing,  by  various  means,  the  irritation 

1  Observations  on  the  Nature,  Causes,  and  Cure  of  Nervous  Disorders,  pp.  1-65. 


EFFECTS  OF  KEFLEX  CHANGES  IN  NUTRITION.  157 

from  the  first  one  reaching  the  nervous  centre,  by  which  a  reflex 
action  is  operated  upon  the  secondarily  attacked  eye. 

These  two  facts  are  now  proved  by  so  many  cases,  that  there  can 
be  no  doubt  as  to  the  mode  of  production  of  the  consecutive  affec- 
tion of  the  eye,  in  both  kinds  of  facts.  However,  there  have  been 
men  of  great  reputation  who  have  doubted  the  correctness  of  the 
etiology  of  these  affections  of  the  eye.  For  instance,  Walther1 
denies  that  there  is  a  single  fact  proving  that  amaurosis  may  be  due 
to  an  injury  of  the  frontal  nerve.  J.  Mueller2  says  that  it  is  much 
more  natural  to  attribute  amaurosis,  following  a  blow  upon  the 
forehead,  to  the  commotion  of  the  eye  and  of  the  optic  nerve ;  and 
Mr.  Sichel3  expresses  the  same  opinions.  But  most  of  the  recent 
works  on  the  diseases  of  the  eyes  contain  many,  and  the  most  posi- 
tive facts,  showing  that  several  kinds  of  affection  of  the  eye  may  be 
the  result  of  an  injury  to  the  frontal  or  of  other  branches  of  the 
trigeminal  nerves.  Besides  some  facts  that  I  shall  relate,  I  will 
mention  the  publications  of  Mr.  Deval,  as  containing  many  facts  of 
this  kind.4 

A  paper  of  Mr.  Notta,  on  Neuralgia,5  shows  that  this  kind  of 
irritation  very  often  causes  congestion  of  the  eye  and  photophobia. 
Out  of  128  cases  of  neuralgia  of  the  trigeminal  nerve,  the  eye  was 
congested  thirty-four  times;  and  in  most  of  those  cases  the  nerve 
attacked  was  the  supra-orbitalis.  Photophobia  existed  in  eighteen 
cases;  and  a  real  ophthalmia  has  sometimes  been  observed.  Mr. 
James,6  a  pupil  of  Magendie,  has  seen  amaurosis  caused  by  a  neu- 
ralgia, Mr.  Notta  (loc.  cit.,  Juillet,  pp.  12-21)  mentions  ten  cases 
of  amaurosis  due  to  neuralgia.  The  short  duration  of  this  amau- 
rosis, its  relapsing  character,  and,  moreover,  its  appearance  during, 
or  immediately  after,  an  attack  of  neuralgia,  and  the  fact  that  it 
was  cured  when  the  neuralgia  was  cured,  prove  that  it  resulted 
from  the  irritation  of  the  trigeminal  nerve.  Alterations  in  the 
cornea  have  been  observed  in  a  very  curious  case  of  neuralgia  of 
the  face,  by  Mr.  Mazade.7  In  a  case  of  hyperaemia  of  the  eye,  which 
had  resisted  for  a  year  many  kinds  of  treatment,  Dr.  Emmerich, 

1  Journal  filer  Chirurgie  und  Augenheilkunde,  1840,  vol.  xxix.  p.  505. 

2  Manuel  de  Physiologie,  Trad.  Francaise,  1851,  p.  707. 

3  Traite  de  l'Ophthalmie,  1837,  p.  697. 

4  See  particularly  his  Traite  de  l'Amaurose,  Paris,  1850,  8vo. 

5  Archives  de  Medecine,  Juillet,  Septembre,  et  Novembre,  1854. 

6  Gazette  Medicale  de  Paris,  1840,  p.  678. 

7  Annales  d'Oculistique,  1848,  p.  128. 


158  THE    CENTRAL    NERVOUS    SYSTEM. 

quoted  by  Schiff,1  states  that  an  immediate  cure  was  obtained  after 
the  extraction  of  a  tooth.  Prof.  Paul  F.  Eve,  of  Tennessee,  U.S., 
suggested  the  idea  of  the  extirpation  of  a  carious  tooth  to  Dr.  II.  F. 
Campbell,2  in  a  case  of  ophthalmia,  and,  the  operation  having  been 
performed,  the  patient  was  at  once  cured.  In  a  case  recorded  by 
Vallez,  quoted  by  Schiff  (foe.  cit.,  p.  116),  there  was  strong  hype- 
remia of  one  eye,  with  abundant  mucous  secretion,  followed  by  an 
ulceration  of  the  cornea,  in  a  man  who  had  received  a  deep  wound 
in  the  face,  dividing  the  supra-maxillary  nerve.  Dr.  Alcock,  in  his 
important  article  on  the  Fifth  Pair  of  Nerves,3  relates  experiments 
on  animals,  in  which  an  injury  to  the  infra-orbitalis  nerve  had  pro- 
duced inflammation  and  suppuration  of  the  eye.  It  is  worthy  of 
remark  that,  in  these  experiments,  when  the  wound  healed  the  eye 
returned  to  its  normal  condition.  Morgagni,4  says  that  Valsalva 
has  seen  amaurosis  instantly  produced  in  a  woman  whose  eyebrow 
had  been  struck  by  the  beak  of  a  cock. 

The  cases  which  prove  the  reflex  influence  of  one  eye  upon  the 
other  are  more  numerous  than  those  showing  the  influence  of  vari- 
ous branches  of  the  trigeminal  nerve  of  one  side  upon  the  corres- 
ponding eye.  Schenk,  Eichter,  Bidloo,  and  many  other  writers  of 
the  two  preceding  centuries,  have  mentioned  facts  proving  that  one 
eye  may  be  affected  by  a  disease  or  an  injury  of  the  other.  In  this 
century,  particularly  in  England,  facts  of  this  kind  have  been  very 
well  studied,  and  the  treatment,  consisting  in  the  extirpation  of  a 
wounded  eye  to  save  the  other,  has  been  applied  many  times.5  The 
happy  influence  of  such  a  treatment  shows,  if  this  were  necessary, 
that  it  is  on  account  of  an  irritation  starting  from  the  first  injured 
eye,  that  the  other  is  affected. 

Even  a  cataract  may  be  produced  in  a  healthy  eye  by  a  nervous 
reflex  influence,  either  from  some  part  of  the  trigeminal  nerve  on 
the  same  side,  or  from  the  other  eye.  Mr.  Notta  mentions  two 
cases,  one  of  a  wound  of  the  frontal  nerve,  and  another  of  neuralgia, 
both  followed  by  cataract.  (Loc.  ciL,  Juillet,  1854,  p.  28.)     Albers 

1  Untersucliungen  zur  Physiol,  des  Nervensystems,  1855,  p.  115. 

2  The  Secretory  and  Excito-Secretory  System  of  Nerves,  1857,  p.  98. 

3  The  Cyclopaedia  of  Anat.  and  Physiol.,  vol.  ii.  p.  312. 

4  De  Sedibus  et  Cansis  Morhorum,  Epist.  xiii.,  s.  5,  vol.  ii.  p.  14. 

5  I  will  refer  to  an  inaugural  dissertation  (These  pour  le  Doctorat,  Paris,  24 
Juillet,  1858,  par  M.  de  Brondeau),  in  which  there  is  a  relation  of  no  less  than 
twenty-four  cases  observed  by  the  author,  showing  the  influence  of  one  eye  upon 
the  other,  for  the  production  of  disease. 


EXAMPLES  OF  EEFLEX  CHANGES  IN  NUTRITION.        159 

relates  a  case  of  a  wound  of  the  cornea  and  the  iris  on  the  right  side, 
followed,  in  three  days,  by  an  opacity  of  the  cornea  of  the  left  eye, 
and  in  eight  days  by  a  cataract  in  this  last  eye.  (De  Brondeau,  he. 
eit,  p.  16.)  Aug.  Berard  has  insisted  extremely1  on  the  necessity 
of  operating  on  one  eye  attacked  with  cataract  to  prevent  the  other 
from  beins:  attacked. 

As  a  second  series  of  examples  of  reflex  changes  in  nutrition, 
I  will  mention  what  takes  place  in  cases  of  sudden  stopping  of  the 
movements  of  the  heart,  in  consequence  of  an  irritation  of  some 
peripheric  parts  of  the  nervous  system.  Whether  the  heart's  move- 
ments depend,  as  I  have  tried  to  show  long  ago,2  upon  an  excita- 
tion from  some  substance  contained  in  the  blood  circulating  through 
the  tissue  of  this  organ  upon  its  muscular  fibres,  or  whether  they 
depend  upon  some  peculiar  rhythmical  change  in  nutrition,  as 
ingeniously  suggested  by  Mr.  James  Paget,3  their  stoppage  in  the 
cases  I  shall  mention  is  produced  by  a  reflex  action. 

The  sudden  death  which  sometimes  occurs  when  very  cold  water 
is  drunk  in  a  warm  day,  or  in  cases  of  a  blow  on  the  abdomen,  of  a 
sudden  perforation  of  the  stomach  or  intestine,  of  a  wound  of  some 
abdominal  viscus  (without  a  notable  hemorrhage),  &c,  seems  to  be 
due  to  a  reflex  stopping  of  the  heart's  action.  I  have  made  a  great 
many  experiments,  which  show  positively  that  a  sudden  excitation 
of  the  abdominal  sympathetic  nerve  sometimes  kills,  and  often 
diminishes  the  movements  of  the  heart,  by  a  reflex  action.4  The 
excitation  goes  up  to  the  spinal  cord,  chiefly  along  the  great 
splanchnic  nerve,  and  ascends  the  spinal  cord  until  the  place  of 
origin  of  the  par  vagum,  and  through  this  pair  of  nerves  it  comes 
to  the  heart.  This  is  proved  by  the  fact  that  a  section  of  either  the 
par  vagum,  or  the  spinal  cord,  or  the  splanchnic  nerves,  allows  any 
kind  of  irritation  to  be  made  on  the  abdominal  sympathetic  without 
a  stopping  taking  place  in  the  heart.  In  some  animals,  the  influence 
of  the  irritation  of  the  sympathetic  in  the  abdomen  is  much  more 
marked  than  in  others;  it  is  so,  probably,  in  man.  I  have  seen  a 
gentleman  suddenly  drop  down  pulseless,  in  the  most  complete 
syncope,  from  a  pain  in  the  abdomen.  The  same  gentleman  is 
easily  attacked  by  syncope  from  any  kind  of  pain.     One  day,  while 

1  Annales  d'Oculistique,  vol.  xi.  p.  183. 

2  Experimental  Researches  applied  to  Physiology  and  Pathology,  1853,  pp.  77 
and  114. 

3  Proceedings  of  the  Royal  Society,  May  28,  1857. 

4  Recherches  sur  les  Capsules  surrenales.     Paris,  1856. 


160  THE    CENTRAL    NERVOUS    SYSTEM. 

I  was  trying  to  bleed  him  with  the  assistance  of  my  learned  friend 
Professor  Natalis  Guillot,  he  had,  as  soon  as  pricked  by  the  lancet, 
a  complete  stopping  of  the  heart's  movements,  and  we  thought,  for 
two  minutes,  that  he  would  die.  I  took  him  by  his  feet,  which  I 
put  on  my  shoulders,  and  then  rising,  I  held  him,  the  head  hanging 
down,  and  he  gradually  recovered. 

It  is  by  the  reflex  influence  due  to  the  sudden  irritation  of  the 
branches  of  the  par  vagum  in  the  lungs  that  chloroform  has  killed 
in  the  very  rare  cases  in  which  the  heart's  action  has  been  stopped 
before  the  respiration.  In  dogs,  in  which  we  can  cause  death  in 
this  way  rather  easier  than  in  other  animals,  I  have  found  that  this 
mode  of  death  never  exists  after  the  section  of  the  par  vagum.  On 
the  other  hand,  I  have  ascertained,  in  the  same  kind  of  animals,  that 
the  state  of  the  heart  is  just  the  same  as  when  death  has  been  pro- 
duced by  the  irritation  (by  galvanism)  of  the  medulla  oblongata  and 
par  vagum,  or  by  the  extirpation  of  the  so-called  vital  knot}  Besides, 
another  proof  that  it  is  in  this  way  that  chloroform  kills  in  the 
cases  which  I  try  to  elucidate  is,  that  in  some  dogs,  on  which  the 
heart's  action  has  been  suddenly  stopped  by  the  inhalation  of  a 
very  large  quantity  of  chloroform,  I  have  been  able  to  restore  life 
by  merely  exciting  the  heart  to  contract  by  mechanical  excitation 
(pressure  on  the  chest). 

I  must  point  out,  apropos  of  the  stopping  of  the  heart's  action  by 
a  reflex  mechanism,  that  one  of  the  means  employed  to  restore  life 
in  asphyxiated  children — which  consists  in  the  alternative  dipping 
of  the  body  in  warm  and  cold  water — is  a  most  dangerous  one. 
No  doubt  that  it  is  a  powerful  means  of  producing  reflex  actions, 
as  long  as  any  reflex  power  remains  in  the  cerebro-spinal  axis,  but 
in  this  very  thing  lies  the  danger.  I  have  seen  puppies  asphyxi- 
ated, and  having  no  more  respiration,  while  the  heart  was  still 
beating  fifteen  or  twenty  times  in  a  minute,  killed  at  once  on  being 
dipped  into  cold  water,  the  heart  stopping  by  a  reflex  action.  I  do 
not  intend  to  say  that  such  a  means  ought  not  to  be  employed;  I 
wish  only  to  point  out  the  chance  of  a  sudden  arrest  of  the  heart's 
action,  so  that  practitioners  may  be  on  the  watch  respecting  this 
accident. 

An  extensive  burn  may  also  produce  a  stopping  of  the  heart's 
movements,  but  it  frequently  produces  other  effects,  which  are 
much  more  interesting,  and  prove  the  great  power  of  the  nervous 

1  See  Journal  de  la  Physiol,  de  PHomrne,  etc.,  No.  2,  Avril,  1S58,  p.  217  et  seq. 


REFLEX  INFLUENCE  OF  BURNS.  161 

system  on  nutrition.  In  an  important  paper  of  Mr.  Long,  of  Liver- 
pool,1 it  is  stated  that  death  was  caused,  in  many  cases  of  extensive 
burns,  by  an  inflammation  of  the  various  viscera.  The  three  follow- 
ing conclusions  have  been  arrived  at  by  Mr.  Long :  1st.  That  in 
almost  every  burn,  indeed  in  every  burn,  lesions  of  one  or  more  of 
the  viscera  contained  in  the  three  great  cavities  exist,  being  accord- 
ing to  their  frequency  as  follows:  abdomen,  chest,  head.  2d.  That 
the  lesions  of  the  different  tissues  contained  in  the  abdomen  are  in 
the  following  order:  mucous  membranes,  serous  membranes,  paren- 
chymatous tissues;  in  the  chest  it  is  quite  the  reverse — namely, 
parenchymatous  tissues,  serous  tissues,  and  lastly  mucous ;  in  the 
head — membranes,  brain.  3d.  That  the  seat  of  internal  inflamma- 
tion corresponds  sufficiently  often  with  the  external  position  of  the 
burn,  but  that  in  a  precisely  equal  number  of  instances  no  such 
correspondence  can  be  traced.  Mr.  Curling,  in  a  paper  on  the  In- 
fluence of  Burns  on  the  Bowels,2  relates  ten  cases  of  ulceration  of 
the  duodenum  as  a  consequence  of  this  powerful  irritation  of  the 
skin.  Lastly,  in  a  very  remarkable  paper,  Mr.  J.  E.  Erichsen3  gives 
the  following  as  the  result  of  observations  of  many  cases  of  burns : — 

The  cerebral  organs  were  diseased  in  33  out  of  37  cases. 
The  thoracic  viscera       "         "        in  30  out  of  40      " 
The  abdominal  viscera  "        "        in  31  out  of  42      " 

I  have  given  these  numbers  to  show  the  frequency  of  this  reflex 
influence  of  burns.  When  I  come  to  the  deductions  to  be  drawn 
from  the  facts  I  have  mentioned  in  this  lecture,  for  the  treatment 
of  disease,  I  will  show  the  importance  of  the  knowledge  of  this  in- 
fluence of  burns,  and  I  will  show,  also,  what  should  be  done  against 
this  frequently  deathly  influence,  according  to  the  view  that  it  acts 
by  a  reflection  from  the  nervous  centres  upon  themselves,  or  upon 
the  thoracic  or  the  abdominal  viscera.4 

When  we  come  to  the  demonstration  that  the  phenomena  which 
we  have  mentioned  in  this  lecture  are  really  to  be  attributed  to  a 
reflex  action,  we  will  show  what  parts  of  the  alterations  in  the 
various  viscera,  after  extensive  burns,  belong  to  a  reflex  influence, 
and  what  parts  are  due  to  other  causes.     But  we  will,  at  once, 

1  Philadelphia  Medical  Examiner,  1840,  p.  492;  from  the  London  Medical 
Gazette,  Feb.  1840. 

2  Medico-Chirurgical  Transactions,  2d  Series,  vol.  vii. 

3  London  Medical  Gazette,  Jan.  1843,  pp.  544  and  588. 

4  That  the  nervous  centres  may  act  upon  themselves,  just  as  upon  other  organs, 
by  a  reflex  action,  will  be  shown  hereafter.  « 

L 


162  THE    CENTRAL    NERVOUS    SYSTEM. 

relate  cases  which  show  that  several  of  the  inflammations  of  internal 
organs  after  burns  may  be  due  to  a  reflex  action,  in  showing  that 
inflammations  in  various  parts  of  the  body  may  be  caused  by  an 
irritation  of  the  nerves  of  the  skin  or  of  other  sensitive  nerves. 

Inflammation  by  a  reflex  action. — In  his  admirable  "  Lectures  on 
Inflammation,"  delivered  in  this  College,  Mr.  James  Paget  said  that 
whoever  has  worked  much  with  microscopes  may  have  observed, 
as  he  has  upon  himself,  that  the  eye  not  employed  becomes  inflamed; 
and  he  adds  that  the  fact  cannot  be  explained  except  by  the  suppo- 
sition that  the  excited  state  of  the  optic  nerve  of  the  working  eye 
is  transferred  or  communicated  to  the  nerves  of  the  conjunctiva  of 
the  other  eye.  He  thinks  that  the  communication  must  take  place 
through  the  encephalon,  and  therefore  by  a  reflex  action.1  I  know 
of  a  most  curious  case  of  inflammation  of  the  cornea  and  conjunc- 
tiva, followed  by  ulceration  and  opacity  of  the  cornea,  due  to  that 
very  cause :  overwork  with  the  microscope.     It  has  occurred  in  a 

distinguished  friend  of  mine,  Dr.  F ,  now  Professor,  at  Lille. 

In  this  case,  anesthesia  and  a  degree  of  atrophy  of  the  face  were 
produced  at  the  same  time  as  the  ophthalmia,  on  the  left  side,  the 
micrographer  making  use  of  the  right  eye.  If  I  had  time  I  would 
endeavor  to  prove  that  it  is  not  by  a  reflex  action  from  the  optic 
nerve,  but  from  the  filaments  of  the  trigeminal,  in  one  eye,  that  this 
inflammation  of  the  other  eye  has  proceeded.  The  recent  works  on 
diseases  of  the  eye  contain  many  cases  of  inflammation  of  this  organ 
by  a  reflex  action,  and  I  will  refer  for  some  cases  of  ophthalmia  due 
to  this  influence  to  the  cases  of  irritation  of  the  dental  nerves,  ob- 
served by  Emmerich  and  by  Dr.  Eve,  and  to  the  experiments  of 
Dr.  Alcock,  which  I  have  already  mentioned. 

It  is  not  rare  that  an  inflammation  of  the  testicle  takes  place  by 
a  reflex  action.  Barras,  quoted  by  Notta  {he.  cit,  Nov.,  p.  547), 
and  Marotte2  relate  cases  of  orchitis  due  to  ileo-scrotal  neuralgia. 
Sir  B.  Brodie3  mentions  a  case  of  inflammation  of  one  testicle  due 
to  the  irritation  of  the  ureter  by  a  calculus,  and  a  case  of  inflamma- 
tory swelling  of  the  face  due  to  a  neuralgia.  Mr.  J.  Paget  (loco  cit.} 
p.  54)  says  that  it  is  through  a  nervous  action  that  the  urethra 
excites  inflammation  of  the  testicle ;  that  the  irritation  of  teething 
excites  this  morbid  nutrition  in  any  distant  part,  and  that  inflam- 

1  Lectures  on  Inflammation,  1850,  p.  12. 

2  L'Uiiion  Medicale,  1851,  p.  155. 

3  Lectures  Illustrative  of  certain  Local  Affections.     London,  1S37,  p.  Il3. 


MUSCULAR  ATEOPHY  BY  REFLEX  ACTION.  163 

mation  of  the  brain  has  been  caused  by  the  application  of  a  ligature 
to  the  brachial  plexus,  as  in  a  case  observed  by  Lallemand. 

Inflammation  of  the  brain  seems  manifestly  to  have  been  gene- 
rated by  a  reflex  influence  in  a  case  recorded  by  M.  P.  Meynier.1 
The  same  thing  may  be  said  of  a  great  many  cases  of  inflammation 
of  the  spinal  cord  or  medulla  oblongata,  in  tetanus  or  trismus  nas- 
centium.2  Other  inflammations  may  be  produced  by  a  reflex  action : 
I  have  seen  purulent  otorrhoea  taking  place  at  every  attack  of 
neuralgia  of  the  auriculo-temporalis  nerve  in  a  young  girl.  I  have 
seen  a  real  inflammation  of  the  stomach,  in  a  dog,  after  the  irritation 
of  the  filaments  of  the  par  vagum  in  the  oesophagus,  and  Professor 
Trousseau  has  made  a  similar  observation.  My  learned  friend,  Mr. 
P.  Broca,  has  seen  several  cases  of  pleurisy  due  to  an  irritation  of 
the  nerves  of  the  breast,  by  some  operations. 

Muscular  atrophy  by  a  reflex  action. — My  friend  and  pupil,  M. 
Clement  Bonnefin,  is  now  collecting  facts  of  this  kind,  and  already 
he  has  found  a  great  many.  He  has  observed  a  very  evident  one 
in  which  the  atrophy  is  due  to  a  neuralgia.  M.  Notta  says  {loco  tit., 
Nov.,  p.  557)  that  in  seven  cases  of  neuralgia  a  more  or  less  exten- 
sive atrophy  has  been  observed.  I  have  seen  two  cases :  one  of 
sciatica,  having  produced  an  atrophy  of  some  of  the  muscles  of  the 
leg ;  the  other,  in  which  pain  starting  from  the  cicatrix  of  a  wound 
on  the  left  forearm  has  caused  atrophy  of  both  arms.  In  the  case  of 
an  injury  to  the  supra-maxillary  nerve  which  I  have  already  men- 
tioned,3 there  was  atrophy  of  the  face.     In  the  case  of  my  friend, 

Dr.  F ,  the  ulceration  of  the  eye,  due  to  irritation  of  the  other, 

is  accompanied  by  an  atrophy  of  some  muscles  of  the  face. 

In  several  of  the  cases  of  muscular  atrophy  collected  by  Dr.  W. 
Roberts,4  there  is  sufficient  evidence  that  this  condition  of  the  mus- 
cles has  been  caused  by  a  reflex  action  (particularly  in  some  cases 
of  Sir  Charles  Bell,  of  H.  Mayo,  of  Aran,  of  Eomberg,  of  Frerichs, 
and  of  Dierner). 

That  the  paralysis  of  atrophied  muscles  is  not  the  only  cause  of 

1  Gazette  Medicale  de  Paris.     Decembre,  1856. 

2  It  is  probable  that  it  is  in  the  same  way  that  inflammation  of  the  spinal  cord 
was  produced  in  those  very  interesting  cases  recorded  by  Dr.  W.  W.  Gull,  and  in 
which  a  disease  of  the  viscera  of  the  pelvis  or  diphtheria  has  preceded  the  symp- 
toms of  myelitis.  (See  the  Medico- Chirurgical  Transactions  for  1856,  and  the 
Lancet,  July,  1858,  p.  4.) 

3  Vallez,  quoted  by  Schiff  (loco  cit.,  p.  115). 

4  An  Essay  on  Wasting  Palsy.     London,  1858. 


164  THE    CENTRAL    NERVOUS    SYSTEM. 

atrophy  is  shown  by  the  fact  that  this  state  of  the  muscles  has  often 
existed  without  paralysis,  or  at  least  before  paralysis,  and  some- 
times although  there  were  convulsions  in  the  muscles.  jSTotta  men- 
tions three  cases  in  which  constant  or  frequent  convulsions  occurred 
while  atrophy  was  increasing. 

Paralysis  and  anaesthesia  by  a  reflex  action. — The  number  of  facts 
of  this  kind  is  immense,  as  shown  in  the  voluminous  papers  and 
works  of  E.  Leroy  d'Etiolles,1  of  Landry,2  and  of  Macario.3  It 
would  be  most  important  to  review  these  cases  to  show  that  they 
cannot  have  been  produced  otherwise  than  by  a  reflex  action,  pro- 
ducing an  alteration  of  either  the  spinal  cord  or  of  some  of  its 
nerves ;  but  we  have  not  time  enough  for  such  a  review,  and  we 
must  therefore  be  content  to  mention  a  few  amongst  those  facts 
which,  more  than  the  others,  seem  to  prove  that  the  cause  of  the 
paralysis  or  of  the  anaesthesia  is  truly  in  a  reflex  action. 

It  is  well  known  that  we  owe  to  Mr.  Edward  Stanley4  the  proof 
that  diseases  of  the  genito-urinary  organs  can  be  the  cause  of  para- 
plegia. Eayer,5  Leroy  d'Etiolles  (loco  cit.\  Macario  (loco  cit.),  and 
others,  have  related  many  facts  which  leave  no  doubt  as  to  the 
possibility  of  existence  of  a  more  or  less  complete  paraplegia  with- 
out any  visible  alteration  of  the  spinal  cord  or  of  its  nerves,  and 
due  to  a  disease  of  either  the  bladder,  the  prostate,  or  the  kidney. 
Other  viscera  of  the  abdominal  and  thoracic  cavities  may  also  be 
the  starting  point  of  a  paralysis ;  Dr.  E.  Graves6  is  the  first  who  has 
well  established  this  etiology  of  certain  kinds  of  paralysis.  In 
children,  the  pretended  essential  paralysis,  so  well  studied  by  Heine, 
Kennedy,  Dr.  "West,  Fliess,  and  Eilliet,7  is  evidently  analogous  in 
its  mode  of  production  with  the  reflex  paralysis  of  adults.  This 
paralysis  of  children  is  almost  always  due  to  the  irritation  of  the 
dental  nerves  or  of  the  bowels. 

Marchal  de  Calvi8  relates  four  cases  of  neuralgia  of  the  fifth  pair 

1  Des  Paralysies  des  Menibres  Inferieurs  ou  Paraplegies,  lere  partie,  1855 ;  2de 
p.,  1857. 

2  Recherches  sur  les  Causes  et  les  Indications  Curatives  des  Maladies  Nerveuses, 
1855. 

3  Gazette  Medicale  de  Paris,  1857,  pp.  564  and  606. 

4  Medico-Chirurgical  Transactions,  vol.  xviii.  p.  260. 

s  Traite  des  Maladies  des  Reins,  vol.  iii.  1851,  p.  16S  et  seq. 

6  Clinical  Lectures  on  the  Practice  of  Medicine.     Ed.  by  Neligan. 

7  Traite  des  Maladies  des  Enfants.  par  Rilliet  et  Barthez,  2d  edition,  1853,  vol.  ii. 
p.  547. 

s  Archives  de  Medecine,  1846,  vol.  xi.  p.  261. 


PAKALYSIS  AND  ANESTHESIA   BY  KEFLEX  ACTION.      165 

of  nerves  which  had  produced  a  paralysis  of  the  third  pair.  Notta 
(loco  cit.,  Sept.  1854,  p.  293)  has  seen  two  cases  of  paralysis  of  the 
elevator  palpebrae,  due  to  a  neuralgia.  Keucourt1  and  M.  Grola2 
have  each  seen  one  case  of  facial  paralysis  cured  at  the  same  time 
that  a  neuralgia,  which  had  caused  it,  was  cured.  Dr.  Badin  d'Hurte- 
bise3  has  seen  a  neuralgia  of  the  supra-orbitalis  nerve  producing  a 
paralysis  of  the  third  and  sixth  pairs  of  nerves,  which  paralysis 
ceased  quickly  after  the  cure  of  the  neuralgia.  Sciatica,  also,  may 
produce  a  paralysis :  Notta  (p.  556)  mentions  a  case  in  which  the 
paralysis  of  the  extensor  muscles  lasted  two  months  after  the  cure 
of  the  sciatica.  Irritation  of  the  bowels  in  adults  has  often  pro- 
duced paralysis:  besides  cases  recorded  by  Dr.  Graves  and  by 
Leroy,  there  are  two  mentioned  by  Professor  Trousseau,4  several 
by  Zabriskie5  and  by  Camper.6  Irritation  of  the  lungs  or  the 
pleurae  may  also  produce  paralysis  :  I  have  seen  a  case  of  this  kind, 
in  1850,  at  the  Charite  Hospital  in  Paris ;  and  Landry  (loco  cit.,  Obs. 
118  and  119)  relates  two  cases.  The  same  thing  has  occurred  in 
diseases  of  the  liver,  without  our  being  able,  in  some  cases,  to  ex- 
plain the  paralysis  by  the  presence  of  bile  in  the  blood.  I  will 
point  out  especially  a  case  of  hepatic  colic  observed  by  Professor 
Fouquier  (quoted  by  Landry,  p.  99)  and  a  case  by  Zabriskie.7  A 
simple  pressure  on  some  sensitive  nerve,  or  a  wound,  may  cause  an 
extensive  paralysis :  so  it  was  in  a  case  that  I  have  observed  with 
my  friend  M.  Charcot,  and  in  cases  recorded  or  mentioned  by 
Pabricius  Hildanus  (quoted  by  Whytt,  loco  cit.,  p.  18),  and  by 
Barthez  (loco  cit.,  vol.  ii.  pp.  41  and  42,  notes,  and  p.  127). 

The  production  of  anesthesia  from  irritation  of  centripetal  nerves 
is  as  common  as  that  of  paralysis  of  movement.  I  have  seen  a  case 
of  anaesthesia  of  the  two  lower  limbs  due  to  sciatica.  M.  Notta  (loco 
cit,  Nov.,  pp.  552-54)  mentions  five  cases  like  this  one — three  ob- 
served by  himself,  one  by  Grisolle,  and  one  by  Martinet.  A  case 
of  anaesthesia  of  the  arm  in  consequence  of  a  cervico-brachial  neu- 
ralgia, is  also  related  by  Mr.  Kotta.  Several  cases  of  more  or  less 
extended  anaesthesia,  due  to  some  kind  of  irritation  of  the  skin, 

1  Arch.,  1849,  vol.  xx.  p.  172. 

2  Bulletin  de  Therapeutique,  1846,  vol.  xxxi.  p.  389. 

3  Annales  d'Oculistique,  1849,  vol.  xxii.  p.  12. 

4  Gazette  des  Hopitaux,  1841,  p.  192. 

5  Med.  Examiner,  1841,  vol.  iv.  p.  750 ;  and  Gaz.  Med.  de  Paris,  1842,  p.  296. 

6  Quoted  by  Barthez,  "  Science  de  l'Homme,"  2d  ed.,  1806,  p.  11,  notes. 

7  Gaz.  Med.  de  Paris,  1842,  p.  296. 


166  THE    CENTRAL    NERVOUS    SYSTEM. 

have  been  collected  in  an  excellent  thesis  of  Mr.  O'Brien.1  In  one 
it  followed  a  bite  of  the  skin  of  the  arm.  I  have  seen  a  young 
woman  who  had  a  partial  ana3sthesia  of  the  face,  with  swelling  and 
infiltration  of  the  cheek,  and  complete  paralysis  of  the  facial  nerve, 
in  consequence  of  neuralgia  of  the  infra-orbitalis  nerve.  I  must 
say  that,  in  this  case,  as  also  in  all  the  cases  of  paralysis  and  ana3s- 
thesia  I  have  mentioned,  the  patients  were  not  hysteric. 

I  will  add  that  in  those  cases — 1st,  the  supposed  cause  has  always 
preceded  the  paralysis  of  movement  or  sensibility ;  2d,  the  changes 
in  the  intensity  of  the  cause  have  usually  been  accompanied  by 
corresponding  changes  in  the  paralytic  symptoms ;  3d,  the  remedies 
against  paralysis  and  anesthesia  have  proved  useless;  4th,  these 
two  affections,  in  many  cases,  have  been  speedily  cured  after  the 
cessation  of  the  irritating  cause ;  5th,  there  was  no  visible  alteration 
of  the  nervous  system  in  several  cases  in  which  an  autopsy  was 
made.  All  these  facts  assuredly  tend  to  show  that  the  paralytic 
symptoms  were  not  due  to  a  disease  of  the  central  nervous  system} 
but  to  an  irritation  of  some  centripetal  nerve ;  and  we  will  show 
hereafter  that  it  was  in  producing  a  peculiar  reflex  action  that  this 
irritation  had  acted. 

Morbid  changes  in  the  nutrition  of  the  brain,  of  the  sjnnal  cord,  and  of 
the  senses  produced  by  an  irritation  of  some  centripetal  nerve. — I  shall 
not  insist  upon  the  demonstration  of  the  influence  that  an  irritation 
of  almost  every  centripetal  nerve  may  have  on  the  production  of 
nervous  affections,  which  show  that  a  change  in  the  nutrition  of 
the  nervous  centres  has  taken  place.  In  one  of  the  lectures  I  have 
still  to  deliver,  I  will  show,  by  an  immense  number  of  recorded 
cases,  that  insanity  in  its  various  forms,  epilepsy,  chorea,  catalepsy, 
extasis,  hydrophobia,  hysteria,  and  all  the  varieties  of  nervous  com- 
plaints, may  be  the  result  of  a  simple,  and  often  slightly  felt,  irrita- 
tion of  some  centripetal  nerve.  I  will  also  then  prove,  or,  at  least, 
endeavor  to  prove,  that  it  is  by  a  reflex  action  of  the  cerebro  spinal 
axis  upon  itself,  through  the  nerves  going  to  its  bloodvessels,  that 
this  irritation  acts  to  alter  the  nutrition  of  this  nervous  centre. 

As  regards  the  influence  of  the  irritation  of  centripetal  nerves  on 
the  nutrition  of  the  senses,  I  will  refer  to  what  I  have  already  said 
of  amaurosis,  adding  on]y  that  the  influence  by  which  worms  acting 
on  the  bowels  cause  the  paralysis  of  the  retina  is  just  the  same  as 

1  Reclierches  sur  l'Anestliesie.     Paris,  1834,  pp.  14,  10,  21,  and  24. 


NEURALGIA  DUE  TO  REFLEX  ACTION.  167 

that  by  which  a  neuralgia  acts  in  causing  the  same  effect.1  Deafness 
has  also  been  caused  by  an  irritation  of  the  nerves  of  the  bowels, 
as  it  has  been  in  two  cases  of  facial  neuralgia.  (Notta,  loco  cit.,  p.  297.) 

Neuralgia  due  to  a  reflex  action. — Dr.  Rowland  mentions  a  girl, 
who  had  paroxysms  of  darting  pain  in  the  left  temple  and  side  of 
the  head.  Upon  inquiry,  it  was  found  that  several  years  previously 
she  had  received  a  severe  cut  over  the  right  parietal  bone,  which 
cut  was  long  in  healing,  and  this  spot  had  been  tender  ever  since. 
A  large  uneven  cicatrix  was  discovered,  and  a  blister  over  this  part 
relieved  the  pain  for  several  weeks.  (Parsons,  Prize  Essay  on  Neu- 
ralgia.2) Sir  Benjamin  Brodie  mentions  a  case  of  stricture  of  the 
urethra  inducing  lameness  and  pain  in  the  foot,  which  were  relieved 
by  the  introduction  of  a  bougie  in  the  urethra.  The  irritation 
caused  by  a  carious  tooth  has  produced  neuralgia  in  the  arm  in 
two  cases.  (Parsons,  loco  cit.,  pp.  423  and  424.)  Neuralgic  hemi- 
crania  is  very  frequently  due  to  gastralgia.  Romberg3  mentions 
several  cases  observed  by  Wardrop,  Abernethy,  Denmark,  and 
others,  in  which  a  neuralgia  in  many  nerves  has  been  caused  by 
the  injury  of  one. 

Various  morbid  influences  due  to  an  invitation  of  centripetal  nerves. — 
I  will  only  point  out  some  of  the  most  interesting  facts.  In  the 
first  place,  I  will  mention  the  herpes  zoster,  which  is  now  almost 
universally  admitted  as  being  often  due  to  a  neuralgia.  Payer,  G. 
Simon,  Notta,  Dr.  Parsons,  Delioux,  Romberg  and  Parrot,4  have 
related  many  cases,  which  leave  no  doubt  on  this  point.  Hasse5 
mentions,  besides  the  zona,  the  following  skin  affections  as  having 
been  caused  by  neuralgia:  erythema,  pemphigus,  and  urticaria.  In 
the  second  place,  I  will  say  that  hypertrophy  of  a  bone,  in  cases 
of  neuralgia,  is  frequent  enough  to  explain  how  Sir  Henry  Halford 
has  been  led  to  imagine  that  tic  douloureux  depends  upon  this 
affection  of  bones.  There  is  no  doubt  that  a  disease  of  bones  can 
produce  neuralgia — and  such  is  the  case  for  the  reflex  neuralgia  of 

1  As  some  persons  deny  that  worms  may  have  this  influence,  I  will  refer  to  a 
paper  of  Mondiere,  in  which  several  unquestionable  cases  are  recorded.  (  Gazette 
des  Ilopitaux,  1840,  p.  139  and  p.  248.)  In  some  cases  an  immediate  cure  has  fol- 
lowed the  expulsion  of  worms.  (IS Experience,  1840,  p.  47,  and  Gaz.  Mid.  de  Paris, 
1845,  p.  655.) 

2  American  Journal  of  Medical  Science,  Oct.  1854,  p.  421. 

3  Lehrbuch  der  Nervenkrankheiten  des  Menschen,  3d  ed.,  1856,  pp.  23-35. 

4  Considerations  sur  le  Zona,  par  J.  Parrot.     Paris,  1857. 

5  Krankheiten  des  Nervenapparates,  in  Virchow's  Handb.  d.  sp.  Pathol.,  vol.  iv., 
1855,  p.  48. 


168  THE    CENTRAL    XERVOUS    SYSTEM. 

most  of  the  branches  of  the  trigeminal  nerve  in  cases  of  caries  of  a 
part  of  the  cranium — but  it  seems  certain  also  that  hypertrophy  of 
bone  may  be  due  to  neuralgia,  as  is  shown  by  cases  of  Komberg, 
Bouillaud,  Neucourt,  and  Bellingeri.  (Notta,  loco  cit.,  Sept.  185-1, 
pp.  311,  312.) 

I  will  only  add  to  the  list  of  effects  of  irritation  of  centripetal 
nerves,  that  oedema,  a  change  in  the  color  and  thickness  of  the  hair, 
and  several  other  morbid  alterations,  have  been  observed,  in  cases 
in  which  they  were  evidently  due  to  that  cause. 

Many  interesting  facts  might  be  added  to  those  which  I  have 
mentioned  as  illustrations  of  the  power  of  an  excitation  of  centri- 
petal nerves  to  act  on  glands,  so  as  to  produce  an  increase  of  all 
the  secretions,  or  to  change  their  nature,  or  to  stop  them,  and  to  act 
also,  at  a  great  or  small  distance,  on  the  various  tissues,  so  as  to 
increase,  diminish,  or  alter  their  nutrition.1  I  come  now  to  the 
explanation  of  the  mode  of  action  of  the  excitation  of  a  centripetal 
nerve  in  those  various  cases. 

The  phenomena  of  sympathy  between  distant  parts  of  the  body 
have,  at  first,  been  explained  by  direct  communications,  which 
were  supposed  to  exist  between  the  nerves  of  the  parts  which  have 
some  sympathetic  influence  one  upon  the  other.  A  second  opinion 
was  that  the  communications  take  place,  partly  through  the  nerv- 
ous centres,  partly  through  anastomoses  of  nerves.  At  last,  after 
Claude  Perrault  and  others,  Robert  Whytt  held  the  view  that  all 
nerves  producing  sympathetic  actions  communicate  only  in  the 
brain  or  spinal  cord.3  Since  the  times  of  Whytt  and  Haller,  who 
agreed  as  regards  this  opinion,  it  had  been  admitted  by  most  phy- 
siologists until  1835,  when  Tiedemann3  tried  again  to  show  that  it 
is  through  anastomoses  of  nerves  that  sympathies  take  place.  But 
after  the  microscope  had  proved  definitively  that  nerve-fibres  re- 
main usually  quite  distinct  one  from  the  other  (a  few  only  uniting 
together),  and  also,  after  the  experiments  of  Kronenberg,  of  Van 
Deen,  and  others,  had  proved  that  the  excitation  of  nerve  fibres 
passing  through  anastomoses  remains  isolated  in  them,  the  old 
theory,  renewed  by  Tiedemann,  has  been  totally  ruined,  and  now 

1  For  several  facts  worthy  of  interest,  I  will  refer  to  the  learned  work  of  Henle, 
"Handbuch  dor  Rationelle  Pathologie,"  vol.  i.  3d  ed.,  1855,  pp.  237-41. 

2  See  his  two  important  works,  "  An  Essay  on  the  Vital  and  other  Involuntary 
Motions  of  Animals,"  2d  ed.,  1763,  and  "  Observations  on  the  Nature,  Causes,  and 
Cure  of  Nervous  Disorders,"  &c,  2d  ed.,  1765,  pp.  9-84. 

3  Zeitschrift  fuer  Physiologie,  vol.  i.,  1835. 


SYMPATHETIC  PHENOMENA.  169 

it  is  universally  acknowledged  that  real  sympathies  require  the 
intervention  of  the  nervous  centres.  But,  although  admitted  as 
the  right  one,  this  view  seems  not  to  be  sufficiently  understood, 
and  the  efforts  made  by  Mueller,  by  Stilling,1  by  Henle,2  by  Dr. 
Marty n  Paine,3  and  others,  have  not  convinced  every  one  that 
changes  in  secretion  and  in  nutrition,  due  to  a  sympathetic  influ- 
ence, are  produced,  in  a  great  measure,  by  the  same  mechanism  as 
that  of  the  reflex  movements. 

Let  us  take  inflammation  as  an  illustration.  An  operation  is 
made  on  the  cervix  uteri,4  and,  one  or  two  days  after,  a  peritonitis 
supervenes,  and  the  patient  dies.  How  has  this  inflammation  been 
produced  ?  Few  persons  will  be  ready  to  explain  this  affection  by 
a  reflex  action  from  the  uterus  to  the  peritoneum,  and  many  would 
laugh  at  the  idea  of  such  an  explanation.  It  is  evident,  assuredly, 
that  the  inflammation  may  have  begun  in  the  uterus,  and  been 
propagated  to  the  peritoneum  by  bloodvessels ;  but  let  us  suppose 
that  no  inflammation  is  found  in  the  uterus  or  in  the  vagina,  how 
then  can  an  inflammation  have  been  produced  in  the  peritoneum, 
in  consequence  of  an  operation  upon  the  cervix  uteri  ?  If  you  do 
not  admit  that  the  excitation  of  the  nerves  of  this  part  of  the 
womb  has  been  propagated  to  the  spinal  cord,  and  thence  reflected 
by  other  nerves  upon  the .  peritoneum,  you  will  not  be  able  to 
explain  the  phenomena  observed.  If  we  take  separately  almost 
any  one  of  the  facts  I  have  mentioned  as  instances  of  reflex  secre- 
tory or  nutritive  actions,  many  persons  will  decline  admitting  with 

1  Physiol.,  Pathol.,  und  Med.  Pract.  Untersuchungen  ueber  die  Spinal  Irritation. 
Leipzig,  1840,  and  Geschichte  einer  Exstirpation  eines  Krankkaft  vergr.  Ovarium's, 
u.  s.  ic.     Hanover,  1841. 

2  Handbuch  der  Rationellen  Pathologie.  Dritte  anflage.  Vol.  i.,  1855,  and  his 
Pathologische  Untersuchungen,  1840,  and  Algemeine  Anatomie,  1841. 

3  The  Institutes  of  Medicine.  New  York,  1847.  The  learned  author  of  this 
work  is  a  solidist  and  a  vitalist,  who  has  carried  the  theory  of  sympathies  of 
Whytt  and  others  far  beyond  the  limits  within  which  it  ought  to  be  restricted. 

4  My  learned  friend,  Mr.  P.  Broca,  has  recently  communicated  to  the  Societe  de 
Chirurgie  of  Paris  the  case  of  a  woman  on  whom  an  application  of  the  actual 
cautery  to  the  cervix  uteri,  after  the  extirpation  of  a  polypus,  was  followed  by  an 
intense  peritonitis  and  rapid  death.  The  state  of  the  uterus  showed  that  this  was 
not  a  case  of  propagation  of  inflammation  from  this  organ  to  the  peritoneum.  See, 
for  a  summary  of  the  case,  the  Lancet,  Nov.  20,  1858,  p.  530,  and,  for  the  details, 
the  Gazette  des  Hopitaux  and  the  Moniteur  des  Ropitaux,  Nov.  1858.  While  I  was 
writing  this  Lecture  another  case,  similar  to  this  one,  has  occurred.  A  woman, 
whose  uterus  has  been  cauterized  by  Mr.  Jobert,  has  died  of  peritonitis,  shortly 
afterward. 


170  THE    CENTRAL    NERVOUS    SYSTEM. 

us  that  it  is  perhaps  really  a  reflex  action.  It  is,  therefore,  neces- 
sary to  say  at  least  a  few  words,  to  show  that  the  sympathetic  phe- 
nomena we  have  mentioned,  and  many  others  of  the  same  kind, 
daily  observed  by  practitioners,  are  reflex  phenomena. 

Suppose  a  foreign  body  in  the  cornea  of  one  eye ;  in  a  short 
time  after  the  cornea  has  been  submitted  to  this  cause  of  irritation, 
we  find  that  the  conjunctiva  is  congested,  photophobia  begins,  and 
tears  are  shed.  There  is  no  bloodvessel  in  the  cornea;  and,  there- 
fore, we  cannot  admit  that  it  is  through  this  kind  of  tissue  that  the 
irritation  has  been  propagated.  Shall  we  admit  that  it  is  through 
the  corneal  tissue  itself,  and  by  its  continuity  or  contiguity  with 
the  other  parts  of  the  eye,  that  the  propagation  has  taken  place  ? 
If  any  one  were  tempted  to  imagine  such  an  explanation,  I  would 
say  that  in  cases  of  disease  or  section  of  the  trigeminal  nerve,  in 
man  and  in  animals,  the  irritation  of  the  cornea  is  not  followed  by 
the  least  appearance  of  congestion  of  the  conjunctiva.  This  con- 
gestion, therefore,  in  cases  where  the  trigeminal  nerve  is  uninjured, 
appears  after  an  irritation  of  the  cornea,  in  consequence  of  the 
transmission  of  the  irritation  to  the  encephalon  by  the  corneal  fila- 
ments of  the  trigeminal.  Now,  how  can  the  congestion  be  pro- 
duced after  the  irritation  has  reached  the  encephalon,  unless  it  be 
by  nerve-fibres  going  from  this  nervous  centre  to  the  eye?  We 
may  have  doubts  as  regards  the  question,  by  what  nerves  the 
encephalon  reacts  upon  the  eye  in  such  a  case ;  but  we  cannot 
doubt  that  it  does  react,  and  that  the  congestion  is  due  to  this 
reaction,  or,  in  other  words,  to  a  reflex  action  of  the  encephalon. 
Still  more,  in  cases  of  irritation  of  one  eye  producing  alterations  in 
the  other  eye,  it  is  clear  that  it  is  through  the  encephalon  that  the 
irritation  is  propagated. 

Let  us  take  another  example :  suppose  we  have  placed  a  tube  in 
one  of  the  ureters  of  a  dog,  so  as  to  know  what  is  the  quantity  of 
urine  flowing  out  in  a  given  time,  after  the  dog  has  recovered 
from  the  shock  of  the  operation.  We  then  pinch  the  internal  sur- 
face of  the  abdominal  wall,  in  a  part  receiving  its  nerves  from  one 
of  the  first  lumbar  pairs,  and,  almost  at  once,  we  find  that  the 
secretion  of  urine  is  either  stopped  or  very  much  diminished.  It 
is  not  in  consequence  of  a  change  in  the  circulation,  due  to  the 
pain  caused  by  the  pinching,  that  the  secretion  is  so  much  dimi- 
nished, as  we  find  the  same  thing  taking  place  whether  the  spinal 
cord  in  the  dorsal  region  has  been  divided  transversely,  or  left  in 
communication  with  the  encephalon.     And  if  the  part  of  the  cord 


VISCEEAL  ALTERATIONS  RESULTING  FROM  BURNS.       171 

which  gives  origin  to  the  lumbar  pairs  of  nerves  has  been  de- 
stroyed— in  which  case  the  urinary  secretion,  after  a  short  stop- 
page, becomes  normal  (as  regards  its  quantity,  at  least),  and  is 
rather  more  than  less  abundant  than  before — we  find  that  the  irri- 
tation of  the  abdominal  wall  remains  without  effect  upon  the  kidney. 
We  must  conclude,  therefore,  that  when  the  spinal  cord  exists,  the 
irritation  passes  through  it,  or,  in  other  words,  that  the  stoppage  of 
the  urinary  secretion  is  due  to  a  reflex  action  of  the  spinal  cord. 
I  have  ascertained,  also,  that  it  is  through  the  spinal  cord,  and  by 
a  reflex  action,  that  the  irritation  of  one  kidney  acts  upon  the  other, 
sometimes  to  diminish,  sometimes  to  increase,  its  secretion. 

Of  course  it  is  not  by  a  reflex  action  only  that  some  of  the  phe- 
nomena mentioned  in  this  lecture  are  produced.  In  a  case  of  ex- 
tensive burns,  for  instance,  there  are  several  circumstances  which 
contribute  to  the  production  of  the  visceral  alterations  so  well 
described  by  Dupuytren,  Mr.  Long,  and  Prof.  Erichsen.  In  the 
first  place,  a  certain  amount  of  blood  is  submitted  to  such  a  tem- 
perature that  several  of  its  parts  (the  globules  especially)  must  be 
altered;  in  the  second  place,  there  is  a  more  or  less  considerable 
diminution  of  the  cutaneous  secretions  and  exhalations,  and,  as 
shown  by  the  experiments  of  Fourcault,  Gluge,  Gerlach,  Ducros, 
Magendie,  Becquerel,  Breschet,  Bouley,  and  my  friend,  Mr.  Bal- 
biani,1  this  is  a  cause  of  congestion  of  the  various  viscera.  But  as 
regards  this  last  circumstance,  there  are  many  cases  of  burns  in 
which  visceral  inflammations  and  rapid  death  have  taken  place 
when  only  a  part  of  the  skin,  not  larger  than  that  of  one  limb,  has 
been  destroyed,  so  that  it  is  impossible  to  admit  that  the  cause  of 
these  inflammations  and  of  death  is  only,  or  even  chiefly,  in  the 
loss  of  the  function  of  the  skin,  the  greater  part  of  which  remains 
in  a  normal  condition.  As  regards  the  other  cause,  the  influence 
of  heated  blood  on  the  viscera,  I  have  made  some  experiments,  the 
details  of  which  I  cannot  relate  now,  which  show  that  in  animals 
in  which  the  spinal  cord  has  been  divided  at  the  level  of  the  third 
or  fourth  lumbar  vertebra,  so  that  the  posterior  limbs  cannot  give 
any  pain,  and  that,  also,  no  irritation  can  be  propagated  from  them 
to  the  viscera  of  the  head,  the  chest,  and  most  of  those  of  the  abdo- 
men, I  have  not  seen — when  I  killed  them  two  or  three  days  after 
I  had  burnt  one  of  the  legs  with  boiling  water — any  marked  alter- 
ations similar  to  those  which  are  so  often  observed  in  man  and 

1  See  his  important  thesis,  "  Essai  sur  les  Fonctions  de  la  Peau,"  &c.  Paris, 
1854,  pp.  94-132. 


172  THE    CENTRAL    NERVOUS    SYSTEM. 

animals  accidentally  burnt,  except  in  the  bladder  and  rectum,  and 
neighboring  organs.  On  the  contrary,  when  the  section  of  the 
spinal  cord  was  made  as  high  as  the  third  dorsal  vertebra,  I  have 
seen  all  the  abdominal  viscera  in  a  state  of  congestion,  very  much 
resembling  inflammation  in  many  parts,  with  serous  infiltrations 
and  ecchymoses,  two  days  after  one  of  the  legs  had  been  burnt  by 
boiling  water. 

It  seems,  therefore,  that  we  are  entitled  to  conclude  that  it  is  not 
only,  and  even  not  chiefly,  to  the  cessation  of  function  in  a  part 
of  the  skin,  nor  to  the  alterations  of  the  blood,  in  cases  of  burns 
having  destroyed  all  the  skin,  and  most  of  the  tissues  of  a  limb, 
that  we  ought  to  attribute  the  inflammations,  or  the  other  altera- 
tions that  the  viscera  present  after  burns.  In  two  cases,  on  animals 
on  which  the  trunks  of  the  sciatic  and  crural  nerves  in  one  limb 
had  been  divided  as  high  as  possible,  I  have  not  found  a  state  of 
marked  congestion  in  any  viscus,  three  days  after  I  had  carbonized 
this  limb  from  the  toes  up  to  the  middle  of  the  thigh.  From  these 
experiments  and  the  preceding,  it  results  that  it  is,  in  a  great  mea- 
sure, by  a  reflex  action  of  the  spinal  cord  that  burns  produce  their 
deadly  influence  on  the  viscera. 

In  the  cases  of  paralysis  or  of  disease  of  the  nervous  centres, 
which  appears  after,  and  as  a  consequence  of,  an  affection  of  a 
gland,  as  a  kidney,  or  the  liver,  I  do  not  need  to  say  there  may  be 
a  cause  entirely  different  from  that  spoken  of  in  this  lecture,  pro- 
ducing the  paralysis  or  the  disease  of  the  nervous  centres:  I  mean 
the  presence  of  a  poison  in  the  blood  on  account  of  the  diminution 
or  alteration  of  an  important  secretion.  There  may  be  also  other 
causes:  for  instance,  Dr.  K.  B.  Todd1  relates  a  curious  case,  show- 
ing that  a  complete  paralysis  of  motion  and  sensation  of  the  lower 
limbs,  apparently  clue  to  a  disease  of  the  kidney  (which  he  sup- 
posed depended  upon  suppressed  gout),  was  cured,  simultaneously 
with  the  renal  disease,  shortly  after  gout  had  been  attracted  to  the 
feet. 

\Ve  have  now  to  examine  how  a  reflex  action  may  produce  or 
stop  a  secretion,  how  it  may  produce  an  atrophy  or  an  hypertrophy, 
an  inflammation,  or  some  other  of  the  various  changes  in  nutrition 
which  we  have  mentioned.  In  the  preceding  lecture  (see  Lecture 
IX.)  we  have  said  that  there  are  two  modes  of  action  of  the  nervous 
system  upon  the  production  of  the  phenomena  of  nutrition  and 

1  Cyclopaedia  of  Anat.  and  Physiol.,  vol.  iv.  p.  721. 


TWO  MODES  OF  ACTION  OF  NERVOUS  SYSTEM.  173 

secretion.  By  one  of  these  actions  the  nervous  system  determines 
an  increase  in  the  attraction  of  blood  by  the  living  tissues,  and  in 
this  case  the  phenomena  are  accompanied  by  a  dilatation  of  the 
bloodvessels;  while  the  reverse  exists  when  the  nervous  system, 
instead  of  acting  upon  the  parenchyma  of  the  tissues,  acts  upon  the 
walls  of  the  bloodvessels  and  produces  a  contraction.  In  the  first 
case,  the  quantity  of  blood,  passing  through  the  part  on  which  the 
nervous  system  has  acted  is  increased;  while  in  the  second  case  it 
is  diminished:  in  the  first  case  the  secretions  are  increased;  in  the 
second,  diminished:  in  the  first  case  nutrition  is  more  active,  and 
there  is  a  tendency  to  hypertrophy  and  an  augmentation  of  the 
vital  properties  of  nerves  and  muscles;  in  the  second  case  nutrition 
is  not  active,  and  there  is  a  tendency  to  atrophy  and  a  diminution 
of  the  vital  properties  of  nerves  and  muscles:  lastly,  in  the  first 
case  there  is  an  augmentation  of  the  temperature;  while  in  the 
second,  there  is  diminution.  There  is,  therefore,  the  most  complete 
difference  between  these  two  nervous  influences. 

Let  us  now  employ  the  knowledge  of  these  two  modes  of  action 
of  the  nervous  system  to  explain  what  occurs  in  some  cases  of 
secretory  or  nutritive  reflex  phenomena.  Suppose,  for  instance,  a 
calculus  in  one  of  the  ureters:  it  irritates  the  centripetal  nerve- 
fibres  of  this  canal,  the  irritation  is  transmitted  to  the  spinal  cord, 
which  reflects  it  upon  the  muscular  coat  of  the  bloodvessels  of  the 
two  kidneys,  and  produces  a  contraction,  in  consequence  of  which 
there  is  much  less  blood  passing  through  these  organs,  so  that  the 
urinary  secretion  is  stopped  or  much  diminished.  Suppose  a  worm 
in  the  bowels,  irritating  their  centripetal  nerve-fibres:  the  irritation 
is  propagated  to  the  spinal  cord,  which  reflects  it  upon  the  roots  of 
the  cervical  sympathetic  nerve,  by  which  it  reaches  the  blood- 
vessels of  the  retina,  produces  their  contraction,  and,  as  a  conse- 
quence of  this  cause  of  diminution  in  the  amount  of  blood,  an 
amaurosis.  If  instead  of  the  reflex  action  on  the  bloodvessels  there 
is  an  action  on  the  tissues,  as  in  the  case  of  the  experiments  of 
Czermak  and  Prof.  Bernard  (see  Lecture  IX.),  the  bloodvessels 
dilate,  and  more  blood  passes  through  them.  The  cornea,  for  in- 
stance, is  irritated ;  its  centripetal  nerve-fibres  transmit  the  irrita- 
tion to  the  pons  Yarolii,  which  reflects  it  upon  the  retina,  the 
'lachrymal  gland,  the  conjunctiva,  &c;  more  blood  is  attracted  by 
all  these  parts,  their  bloodvessels  dilate,  and  the  consequences  of 
a  greater  amount  of  blood  become  manifest  (increase  of  tears,  pho- 
tophobia, &c). 


174  THE    CENTRAL    NERVOUS    SYSTEM. 

The  two  kinds  of  effects  produced  by  the  nervous  system  on 
nutrition  and  secretion,  may  coexist  or  follow  each  other ;  and  we 
have  instances  of  such  a  combination  or  alternation  in  cases  of 
neuralgia,  of  worms,  &c. 

The  simple  fact  of  an  increase  or  a  diminution  in  the  quantity  of 
blood  passing  through  a  part,  in  a  given  time,  is  assuredly  enough 
to  explain  the  physiological  and  some  of  the  morbid  changes  in 
secretion  and  nutrition  which  are  usually  observed;  but  some  other 
morbid  changes  seem  to  require  more  than  a  simple  change  in  the 
amount  of  blood  for  their  production.  For  instance,  an  inflam- 
mation cannot  be  explained  by  such  a  change  only,  as  we  see  that 
after  the  section  of  the  cervical  sympathetic  nerve  a  very  con- 
siderable increase  in  the  quantity  of  blood  exists  in  the  eye,  the 
ear,  &c,  and  lasts  for  many  weeks  or  months  without  an  inflam- 
mation. It  is  true  that  this  morbid  process  supervenes  much 
easier  by  far  in  those  parts  than  in  others ;  but,  we  repeat,  that  it 
does  not  appear  spontaneously,  and  simply  on  account  of  the  quan- 
tity of  blood.  We  must,  therefore,  admit,  that  when  a  nervous 
influence  acts  upon  certain  tissues  to  produce  inflammation,  the 
principal  cause  of  this  morbid  process  is  not  in  the  augmentation 
of  the  quantity  of  blood,  but  in  the  change  in  the  tissues  which 
produces  a  greater  attraction  of  arterial  blood.1 

The  history  of  the  treatment  of  disease  by  means  of  the  powerful 
influence  of  an  excitation  of  centripetal  nerves  on  remote  organs, 
could  afford  us  as  many  interesting  facts  as  the  history  of  the  reflex 
production  of  inflammation  and  other  morbid  changes.  But  as  I 
have  not  time  enough  to  dwell  on  this  subject,  I  will  content  my- 
self by  indicating  some  rules  of  treatment  founded  upon  the  know- 
ledge of  reflex  actions. 

1st.  When  we  wish  to  produce  a  modification  in  the  condition  of 
any  organ,  we  must  apply  the  means  of  irritation  that  we  prefer  to 
the  part  of  the  skin  or  of  the  mucous  membranes  which  have  the 

1  We  regret  very  much  not  to  be  able  to  examine  fully  here  this  great  question 
of  the  production  of  inflammation,  either  by  a  reflex  action  or  by  other  causes. 
We  regret  also  not  to  be  able  to  show  how  much  the  recent  advances  of  science 
agree  with  most  of  the  observations  made  by  Dr.  Hughes  Bennett,  Dr.  C.  J.  B. 
Williams,  Mr.  Wharton  Jones,  and  Mr.  James  Paget.  We  do  not  agree  entirely 
with  Mr.  Joseph  Lister,  whose  very  important  researches  we  know  only  by  a  sum- ' 
mary  of  his  paper  (Proceedings  of  the  Royal  Society,  vol.  viii.,  No.  27, 1857,  p.  581), 
but  we  can  say  that  his  view,  that  a  change  occurring  in  the  tissues  around  the 
bloodvessels  is  the  primary  act  in  inflammation,  might  be  supported  by  many  facts 
entirely  different  from  those  so  interesting  which  he  has  discovered. 


TREATMENT  OF  DISEASE  FROM  REFLEX  ACTION".         175 

most  evident  nervous  relations  with  it.  In  most  cases  the  parts 
acting  with  the  greatest  power  upon  another  are  those  which  receive 
their  nerves  from  the  same  segment  of  the  cerebro- spinal  axis.  If 
we  wish,  for  instance,  to  act  upon  the  kidney,  the  skin  of  the  abdo- 
men in  its  upper  part  is  the  best  for  the  application  of  any  kind  of 
irritation.  Do  we  wish  to  act  on  the  eye,  in  cases  of  amaurosis  due 
to  insufficiency  in  the  amount  of  blood,  the  irritation  ought  to  be 
applied  chiefly  to  the  supra  or  infra-orbitalis  nerves.  If  the  amau- 
rosis co-exists  with  hyperemia,  the  irritation  of  those  nerves  must 
be  avoided,  and  the  means  of  revulsion  ought  to  be  applied  on  the 
back  of  the  neck,  so  as  to  act  on  the  spinal  cord,  and,  through  it, 
by  the  sympathetic  nerve,  which  has  on  the  eye  an  influence  en- 
tirely different  from  that  of  the  trigeminal  nerve.  In  cases  of  diar- 
rhoea, an  influence  upon  the  nerves  of  the  bowels  originating  from 
nearly  the  middle  of  the  dorsal  region  might  be  obtained  by  the 
irritation  of  the  skin  of  the  middle  of  the  chest.  The  ovaries  and 
the  uterus  being  able  to  influence  the  nutrition  of  the  mammas,  and 
these  glands  being  able  to  act  upon  the  genital  organs,  irritation 
will  be  applied  to  one  group  of  these  organs  when  we  wish  to  act 
upon  the  other.  In  amenorrhcea,  for  instance,  various  means  of 
irritation  to  the  breast  have  produced  menstruation. 

2d.  The  kinds  of  irritation  which  produce  the  most  powerful 
effects  are  a  great  and  sudden  change  of  temperature,  heat  or  cold, 
or  th$  application  of  a  very  strong  galvanic  current.  Frequent 
irritations,  with  periods  of  interruption  between  them,  are  better 
than  permanent  irritations. 

3d.  The  suppression  of  the  cause  of  irritation,  when  a  disease  is 
produced  by  a  reflex  action,  is  of  course  the  principal  mode  of 
treatment.  In  cases  of  paralysis,  of  anaesthesia,  or  of  a  convulsive 
affection,  &c,  we  must  try  to  find  out  if  there  is  an  irritation  on 
any  centripetal  nerve,  and  employ  the  most  energetic  means  for  its 
removal.  But  I  must  say  that  it  is  entirely  useless  to  amputate  a 
limb,  or  a  part  of  it,  as  has  been  done  sometimes  in  cases  of  con- 
vulsive affections  produced  by  an  external  irritation.  The  section 
of  a  nerve  will  do  as  well,  and  this  is  already  proved  by  many 
cases,  and  perhaps,  as  I  will  show  in  my  last  lecture,  a  simpler 
means  might  be  employed. 

4th.  Time  pressing  me  to  go  on,  I  will  only  add  here  that  in  cases 
of  reflex  congestions  or  inflammations  due  to  burns  or  to  congela- 
tion, or,  in  fact,  in  any  case  in  which  we  have  to  avoid  a  reflex  in- 
fluence, we  must  diminish  the  reflex  faculty  of  the  spinal  cord  and 


176  THE    CENTRAL    NERVOUS    SYSTEM. 

encephalon,  and  we  know  no  medicine  having  so  much  power  in 
this  respect  as  belladonna. 

Direct  influence  of  the  nervous  centres  and  of  the  centrifugal  nerves 
upon  nutrition  and  secretion. — I  will  only  say  here,  that  the  same 
phenomena,  which  we  have  described  as  taking  place  by  reflex 
actions,  can  be  produced  also  in  consequence  of  a  direct  irritation 
upon  the  nervous  centres  and  the  centrifugal  nerves.  The  pheno- 
mena due  to  this  direct  irritation  have  very  often  been  mistaken  for 
consequences  of  absence  of  action  of  the  nervous  centres.  I  will 
merely  point  out  here  the  rapid  sloughs  that  are  observed  after  a 
fracture  or  a  luxation  of  the  vertebral  column,  and  the  rapid  change 
in  the  urinary  secretion  in  similar  cases.  As  regards  the  effects  of 
direct  irritation  of  centrifugal  nerves,  the  following  case,  in  which, 
however,  there  was  probably  some  indirect  influence  of  the  nervous 
centres,  has  been  observed  by  Mr.  Hilton,  and  published  by  Mr. 
Paget :  "  A  man  was  at  Guy's  Hospital,  who,  in  consequence  of  a 
fracture  at  the  lower  end  of  the  radius,  repaired  by  an  excessive 
quantity  of  new  bone,  suffered  compression  of  the  median  nerve. 
He  had  ulceration  of  the  thumb  and  fore  and  middle  fingers,  which 
resisted  various  treatment,  and  was  cured  only  by  so  binding  the 
wrist  that,  the  parts  on  the  palmar  aspect  being  relaxed,  the  pres- 
sure on  the  nerve  was  removed.  So  long  as  this  was  done,  the 
ulcers  became  and  remained  well;  but  as  soon  as  the  man  was 
allowed  to  use  his  hand,  the  pressure  on  the  nerves  was  renewed, 
and  the  ulceration  of  the  parts  supplied  by  them  returned."1  Mr. 
Paget  also  relates  a  case  of  Mr.  Swan,  which  has  great  analogy  with 
the  preceding.  These  two  patients  might  have  been  cured  at  once 
by  the  section  of  the  irritated  nerves. 

I  will  only  add,  as  regards  the  influence  of  the  pressure  on  the 
spinal  cord  producing  sloughs  on  the  nates  and  other  morbid 
changes,  that  it  is  chiefly  in  exciting  a  persistent  contraction  in  the 
bloodvessels  of  the  parts  where  nutrition  or  secretion  is  morbidly 
altered,  that  the  pressure  on  the  cord  acts.  As  it  often  happens 
that  death,  after  a  fracture  or  a  luxation  of  the  spine,  is  due  to  the 
slough  formed  on  the  nates,  I  think  I  must  remark  that  a  very  good 
means  of  dilating  bloodvessels  consists  in  exhausting  their  irrita- 
bility by  applications  of  powerful  galvanic  currents. 

Influence  of  the  absence  of  the  nervous  system  upon  nutrition  and 
secretion. — If  I  had  time,  I  would  show  that  most  of  the  morbid 

1  Lectures  on  Surgical  Tathologj,  vol.  i.  pp.  42-43. 


INFLUENCE    OF    NERVOUS    SYSTEM    ON    ANIMAL    HEAT.     177 

changes  which  have  been  attributed  to  paralysis  do  not  belong  to 
it,  but  are  the  results  of  irritation  upon  either  the  nervous  centres 
or  the  nerves ;  and  that  the  effects  which  are  truly  the  consequences 
of  a  paralysis  are  due,  only  in  an  indirect  way,  to  the  absence  of 
nervous  action.  For  instance,  atrophy  of  muscles  is  chiefly  due  to 
the  state  of  rest;  changes  in  secretion  are  chiefly  due  to  the  para- 
lytic dilatation  of  bloodvessels ;  ulcerations  of  the  toes,  in  animals 
in  which  the  nerves  of  the  limbs  have  been  divided,  only  show  an 
effect  of  the  rubbing  of  the  same  parts  on  a  hard  floor;  ulceration 
and  inflammation  of  the  eye  after  the  section  of  the  trigeminal  nerve, 
are  chiefly  due  to  physical  causes  (the  drying  of  the  cornea  and  the 
conjunctiva,  the  prolonged  action  of  light,  &c).  All  these  effects  of 
paratysis  may  be,  and  have  sometimes  been,  avoided. 

On  the  other  hand,  if  we  try  to  find  out  what  is  the  power  of 
cicatrization  and  repair,  in  cases  of  paralysis  not  complicated  by 
irritation  of  nerves,  we  ascertain,  as  has  long  ago  been  done  by  Sir 
Benjamin  Brodie,1  and  as  we  have  done  since,  and  in  varying  more 
the  mode  of  experimenting,2  that  wounds,  burns,  and  fractures  may 
be  cured  as  quickly  in  paralyzed  parts  as  in  others.  Many  facts 
might  be  advanced  to  prove  (as  in  the  preceding)  that  if  the  influ- 
ence of  the  nervous  system  is  indirectly  necessary  to  nutrition  and 
secretion,  it  is  nevertheless  true  that  all  the  phenomena  of  nutrition 
and  secretion  may  remain  normal  when  the  action  of  the  nervous 
system  on  the  various  tissues  is  missing. 

Influence  of  the  nervous  system  on  animal  heat. — We  do  not  pro- 
pose, in  these  lectures,  to  treat  exprofesso  of  this  influence;  we  only 
wish  to  show  what  is  the  cause  of  the  local  diminution  or  augment- 
ation of  temperature  in  paralyzed  parts.  As  it  is  chiefly  in  cases 
of  disease  of  the  pons  Varolii  and  medulla  oblongata  that  these 
local  changes  of  temperature  are  interesting  in  a  practical  point  of 
view,  we  will  postpone,  till  our  lecture  on  these  organs,  the  develop- 
ment of  our  views  on  this  subject.  We  will  say  here,  however, 
that  the  temperature  of  a  superficial  part  of  the  body,  or  of  a  whole 
limb,  depends  greatly  upon  the  state  of  the  central  nervous  system; 
and  that  we  may  judge  pretty  well  of  this  state  by  the  degree  of 
temperature  of  the  feet,  of  the  hands,  &c. 

1  See  the  "Treatise  on  Nervous  Diseases,"  by  J.  Cooke,  vol.  i.,1820,  pp.  130-133. 

2  Experimental  Researches  applied  to  Physiology  and  Pathology,  New  York, 
1853,  pp.  6-17. 

M 


178 


LECTURE    XI. 

ON  THE  ETIOLOGY,  NATURE,  AND  TREATMENT  OF  EPILEPSY,  WITH  A 
FEW  REMARKS  ON  SEVERAL  OTHER  AFFECTIONS  OF  THE  NERVOUS 
CENTRES. 

Artificial  production  of  an  epileptiform  affection  in  animals. — Influence  of  certain 
injuries  to  the  spinal  cord  as  a  cause  of  real  epilepsy. — Existence  of  an  unfelt 
aura  epileptica  in  many  cases. — Means  of  detecting  the  existence  of  an  unfelt 
aura  and  its  point  of  starting. — Seat  and  nature  of  epilepsy. — Principles  of  treat- 
ment of  this  affection. — Analogy  between  epilepsy  and  many  other  nervous  affec- 
tions, as  regards  their  mode  of  production  and  their  treatment. — Curious  case  of 
convulsions  and  insanity,  in  illustration  of  some  views  advanced  in  this  letter. 

Mr.  President  and  Gentlemen  :  It  is  impossible  in  the  narrow 
compass  of  a  lecture,  to  treat  fully  of  the  great  variety  of  interest- 
ing points  concerning  several  grave  affections  of  the  cerebro -spinal 
centre.  I  must,  therefore,  though  I  much  regret  it,  limit  myself 
to  a  short  sketch  of  some  new  views,  which,  perhaps,  deserve  the 
attention  of  both  practitioners  and  men  of  science.  Although  I 
will  only  mention  here  a  few  of  the  principal  facts  which  have  led 
me  to  these  views,  I  hope  it  will  be  understood  that,  if  I  do  not  try 
to  give  a  complete  demonstration  of  them,  it  is  because  such  a 
thing  is  impossible  in  a  single  lecture. 

I  have  found  that  a  convulsive  affection,  very  much  resembling 
epilepsy,  may  be  produced  in  animals.  A  few  weeks  after  certain 
injuries  to  the  spinal  cord,  in  the  dorsal  or  the  lumbar  region,  espe- 
cially in  guinea-pigs,  fits  appear  spontaneously  several  times  a  day, 
or,  at  least,  once  every  two  or  three  days.  But  the  most  interest- 
ing point  is,  that  it  is  possible  to  produce  a  fit  when  we  choose,  by 
simply  pinching  a  certain  part  of  the  skin.  These  fits  consist  in 
clonic  convulsions  of  almost  all  the  muscles  of  the  head,  the  trunk, 
and  the  limbs,  except  those  muscles  which  are  paralyzed.  The 
animal  seems  to  have  lost  its  consciousness,  or,  at  least,  its  sensi- 
bility. There  is  an  evident  laryngismus  in  the  beginning  of  the 
fit,  and,  after  it,  when  it  has  lasted  long,  a  state  of  drowsiness  or  un- 


ARTIFICIAL    EPILEPSY    IN    ANIMALS.  179 

willingness  to  move.1  I  have  ascertained  that  one  part  only  of  the 
skin  has  the  power  of  producing  the  fit,  and  this  part  is  that  which 
covers  the  angle  of  the  lower  jaw,  and  extends  from  thence  to  the 
eye,  the  ear,  and  nearly  to  the  shoulder.  It  is  only  the  skin  that 
has  the  power  of  generating  the  fit,  as  even  the  three  nerves  that 
send  filaments  to  this  part  of  the  skin  can  be  irritated  without  the 
occurrence  of  convulsions. 

When  the  spinal  cord  has  been  injured  only  on  the  right  side, 
it  is  only  on  that  side  that  the  skin  of  a  part  of  the  face  and  neck 
has  the  power  of  inducing  fits,  et  vice  versd  when  the  injury  exists 
on  the  left  side.  If  the  two  sides  of  the  cord  are  injured,  the  two 
sides  of  the  face  can  produce  fits.  It  is  not  the  pain  due  to  the 
irritation  of  the  skin  which  causes  convulsions,  as  I  have  ascer- 
tained that  the  degree  of  sensibility  of  that  part  of  the  face  and 
neck  is  not  greater  than  that  of  the  neighboring  skin,  and  is  less 
(by  far)  than  that  of  some  parts  of  the  skin  in  one  of  the  abdo- 
minal limbs.  It  is  evidently  a  peculiar  kind  of  irritation,  starting 
from  the  cutaneous  ramifications  of  some  centripetal  nerves,  which 
alone  possesses  the  power  of  producing  the  epileptiform  convul- 
sions which  are  observed  in  animals  in  which  the  spinal  cord  has 
been  submitted  to  certain  injuries. 

It  results  from  the  facts  which  have  led  me  to  the  above  asser- 
tions:2— 

1st.  That  the  spinal  cord  in  animals  may  be  the  cause  (I  do  not 
say  the  seat)  of  an  epileptic  affection. 

2d.  That  there  is  a  mysterious  relation  between  certain  parts  of 
the  spinal  cord  and  remote  parts  of  the  skin  of  the  face  and  neck. 

3d.  That  epileptiform  convulsions  may  be  the  constant  conse- 
quence of  slight  irritations  upon  certain  nerves. 

4th.  That  the  trunk  of  a  nerve  may  not  have  the  power  of  pro- 
ducing convulsions,  whilst  its  cutaneous  ramifications  possess  this 
power. 

5th.  That  even  when  an  epileptiform  affection  has  its  primitive 
cause  in  the  nervous  centres,  some  cutaneous  filaments  of  nerves, 

1  For  more  details  on  this  point,  and  on  others  concerning  epilepsy  in  this  lec- 
ture, see  my  "  Researches  on  Epilepsy,"  &c,  Boston,  1857,  and  the  Journal  de  la 
Physiologie  de  V Homme  et  des  Anunaux,  1858,  pp.  241  and  472. 

2  To  those  readers  of  these  lectures  who  have  not  been  amongst  my  hearers,  I 
must  say  that  I  have  shown  the  principal  experiments  relative  to  this  subject,  as 
well  as  to  most  of  the  principal  subjects  of  my  lectures,  so  that  my  assertions  were, 
very  often,  accompanied  by  an  actual  and  direct  demonstration. 


180  THE    CENTRAL    XERVOUS    SYSTEM. 

not  directly  connected  with  the  injured  parts  of  these  centres,  have 
a  power  of  producing  convulsions,  which  other  nerves,  even 
directly  connected  with  them,  have  not. 

In  man,  epilepsy  very  frequently  presents  most  of  these  pecu- 
liarities. As  regards  the  first  of  them,  it  cannot  be  doubted  that 
a  disease  of  the  spinal  cord  or  of  its  membranes,  as  well  as  an  affec- 
tion of  any  centripetal  nerve  in  the  human  body,  may  be  the  pri- 
mitive origin  of  a  real  epilepsy,  quite  similar  to  the  erroneously- 
called  idiopathic  epilepsy.  I  will  refer  to  cases  recorded  by  Bonet, 
Lieutaucl,  Morgagni,  Musel,  Portal,  Esquirol,  and  a  great  many 
other  excellent  observers.  The  careful  study  of  these  cases  shows 
clearly  that  in  a  number  of  them  epilepsy  has  truly  been  generated 
by  the  disease  of  the  spinal  cord. 

I  do  not  know  yet  of  any  case  in  which,  in  man,  just  the  same 
thing  has  been  observed  as  in  my  epileptic  animals.  But  there  are 
only  very  few  cases  on  record  in  which  the  very  injury  which  in 
them  has  caused  epilepsy,  has  been  observed  in  man ;  and  in  those 
cases  in  which  probably  this  injury  has  existed,  we  either  do  not 
know  what  have  become  of  the  patients,  or  they  have  died  before 
the  time  after  which  epilepsy  appears  in  animals  after  the  injury 
to  the  spinal  cord.  But  there  are  many  cases  on  record  in  which 
an  irritation  of  some  point  of  the  skin,  or  of  some  centripetal 
nerve,  and  sometimes  even  an  unfelt  irritation,  has  produced  fits, 
just  as,  in  my  animals,  the  excitation  of  a  part  of  the  skin  pro- 
duces them. 

I  have  collected  such  a  number  of  facts  in  this  respect,  that  the 
analogy  between  epilepsy  in  man  and  in  my  animals  seems  to  be 
as  great  as  possible ;  and  I  may  add  that,  in  most  cases  of  genuine 
and  complete  epilepsy,  as  well  as  in  cases  of  simple  vertigo,  there 
is  an  irritation  starting  from  some  point  of  a  centripetal  nerve, 
especially  from  its  peripheric  parts  in  the  skin,  or  in  the  various 
mucous  membranes.  There  is  no  medical  man  who  has  been  in 
practice  for  a  few  years,  who  has  not  seen  some  cases  of  this  kind ; 
but  almost  all  the  recent  writers  on  epilepsy  having  considered 
those  cases  as  quite  special,  I  must  insist  on  saying,  that  even  in  the 
so-called  idiopathic  epilepsy  there  may  be  found  an  irritation  start- 
ing from  some  centripetal  nerve,  and  generating  the  convulsions; 
and  I  must  add,  also,  that  there  is  no  radical  difference  between 
the  symptoms  of  the  sympathetic  epilepsy,  and  those  of  the  pre- 
tended idiopathic. 

I  will  leave  aside  here  all  the  cases  in  which  an  evident  irritation 


UXFELT    AUEA    EPILEPTICA.  181 

on  a  centripetal  nerve  has  caused  epilepsy,  such  as  cases  of  worms 
in  the  bowels,  in  the  biliary  ducts,  or  in  the  frontal  sinus;  of  calculi 
in  the  ureter,  in  the  biliary  ducts,  &c;  of  foreign  bodies  in  the  ear 
or  beneath  the  skin;  of  tumors  pressing  on  nerves;  of  decayed 
teeth;  of  necrosed  bones,  &c.  But  I  must  say  that  in  several  cases 
the  peripheric  origin  of  fits  has  been  quite  evident,  as  it  was  suffi- 
cient to  press  upon  a  certain  part  of  the  skin  to  produce  the  epi- 
leptic seizure.1  In  other  cases,  a  draught  of  cold  air,  the  applica- 
tion of  a  galvanic  current  to  certain  parts  of  the  skin,  a  sound,  a 
smell,  or  the  sight  of  a  certain  color,  were  always  followed  by  a 
fit. 

In  cases  of  aura  epileptica  there  is  the  greatest  variety  in  the 
sensations  felt,  and  the  degree  and  the  painfulness  of  the  sensations 
are  not  such  that  we  could  explain  by  them  the  production  of  con- 
vulsions. It  results  from  a  thorough  examination  of  a  great  many 
cases  of  aura,  that  we  must  admit  that  an  unfelt  irritation  starts,  at 
the  same  time  as  the  aura,  from  some  centripetal  nerve,  and  is  the 
real  cause  of  the  epileptic  seizure.  We  will  call  this  irritation  an 
unfelt  aura;  and  it  would  be  well,  indeed,  if  we  could  employ  the 
name  of  "aura  epileptica"  for  this  unfelt  irritation  alone,  so  as  to 
distinguish  it  completely  from  the  vague  and  variable  sensations 
which  accompany  it  in  many  cases.  There  are  facts  proving  that 
an  unfelt  aura  may  exist  without  any  kind  of  sensation,  either 
because  the  first  effect  of  the  irritation  has  been  to  destroy  con- 
sciousness, or  because  the  irritation  does  not  start  from  sensitive 
nerve-fibres,  but  from  centripetal  nerve-fibres  endowed  only  with  the 
excito-motory  power.2 

It  is  very  important,  on  account  of  the  treatment,  to  find  out  if 
there  is  an  unfelt  aura,  and  what  is  its  starting  point.  In  conse- 
quence of  this  view,  the  condition  of  all  the  organs  of  the  body 
ought  to  be  carefully  inquired  into. 

If  the  unfelt  aura  starts  from  some  parts  of  the  skin,  or  from 
some  organ  not  deep-seated,  as  the  testicle,  or  some  part  of  mucous 
membranes,  near  the  skin,  either  the  first  contractions  in  a  fit,  or 
the  most  violent  or  the  most  prolonged,  are  found  in  the  neighbor- 

1  See  my  "  Researches  on  Epilepsy,"  pp.  31,  32,  38,  and  48.  I  might  add  seve- 
ral other  cases  observed  by  myself  or  others. 

2  See  the  curious  cases  of  Pontier,  of  Joseph  Frank,  and  of  Henricus  ab  Heer,  in 
my  "  Researches  on  Epilepsy,"  p.  32.  In  cases  of  worms  producing  epileptic  fits, 
there  is,  sometimes,  no  sensation  at  all  accompanying  the  unfelt  irritation  which 
causes  the  convulsions. 


182  THE    CENTRAL    NERVOUS    SYSTEM. 

hood  of  the  point  of  starting  of  the  aura.  If  no  indication  of  this 
kind  can  be  furnished  by  the  persons  who  have  seen  the  fits,  it  will 
be  well  to  try  the  application  of  a  very  powerful  galvanic  current, 
with  dry  conductors,  on  the  various  parts  of  the  skin,  when  the 
patient  expects  to  have  a  fit.  I  have,  in  this  way,  twice  ascer- 
tained the  point  of  starting  of  an  unfelt  aura :  a  fit  has  been  pro- 
duced by  the  galvanization  of  certain  parts  of  the  skin.  Of  course 
there  are  many  cases  where  such  a  means  of  diagnosis  ought  not 
to  be  employed :  every  one  will  understand  what  are  those  cases. 

Another  and  the  best  means  (so  far  as  the  limbs  alone  are  con- 
cerned), to  detect  the  existence  of  an  unfelt  aura,  consists  in  appli- 
cations of  ligatures  on  each  limb  alternately.  Suppose  a  case  of 
epilepsy  in  which  the  fits  are  frequent,  and  come  at  nearly  fixed 
times,  or  after  warnings  of  any  kind,  so  that  it  may  be  known  that 
it  is  to  take  place  in  a  given  time,  or  nearly  so :  a  very  tight  liga- 
ture is  put  on  one  limb;  and  if  the  fit  does  not  come,  it  is  extremely 
probable  that  it  depends  on  the  irritation  of  an  unfelt  aura;  if  it 
comes,  the  ligature  is  applied  on  the  other  limbs  at  other  times.  I 
am  sorry  not  to  be  able,  to  give  more  details  in  this  respect;  but  I 
think  it  will  be  easy  to  understand  how,  by  such  a  means,  it  may 
be  ascertained  if  an  aura  comes  from  the  upper  part  of  a  limb,  or 
from  a  toe  or  a  finger,  and  from  which  one. 

Even  in  cases  of  epilepsy  due  to  a  disease  of  the  encephalon,  the 
cause  of  the  fits  may  originate  from  some  points  of  the  skin,  and 
the  prevention  of  the  passage  of  the  aura,  in  such  cases,  can  pre- 
vent the  fits.  There  are  four  cases  of  this  kind  that  I  know,  in 
three  of  which  the  disease  consisted  in  a  tumor  in  the  brain.  In 
my  animals  the  same  thing  exists;  although  the  alteration  of  the 
spinal  cord — which  is  the  cause  of  epilepsy — persists,  the  aura 
being  interrupted  by  the  section  of  the  nerves  which  go  to  the  skin 
of  the  neck  and  face,  epilepsy,  so  far  as  I  have  been  able  to  ascer- 
tain, ceases.  The  aura  may  originate  from  any  part  of  any  centri- 
petal nerve,  and  there  is  no  doubt  that  its  place  varies  according 
to  the  location  of  disease  in  the  nervous  centres,  when  it  is  due  to 
such  a  disease. 

A  great  many  cases  in  which,  by  various  means,  the  aura  epilep- 
tica  has  been  prevented  from  going  up  to  the  encephalon,  show  that 
the  fit  is  very  often  due  to  a  simple  outside  irritation.  Applica- 
tions of  ligatures,  sections  of  nerves,  amputations,  &c,  act  in  this 
way.  We  might  say  the  same  thing  of  the  elongation  of  muscles 
(the  first  ones  that  are  convulsed),  and,  in  a  certain  measure,  of 


SEAT    AND    NATURE    OF    EPILEPSY. 


183 


various  means  of  revulsion  (such  as  burning,  blistering,  &c),  al- 
though the  principal  mode  of  action  then  consists  in  producing,  by 
a  reflex  action,  a  change  in  the  nutrition  of  the  nervous  centres,  and 
of  the  nerves  which  are  the  channels  of  the  aura. 

Epilepsy  seems  to  consist  essentially  in  an  increased  reflex  ex- 
citability of  certain  parts  of  the  cerebro-spinal  axis,  and  in  a  loss  of 
the  control  that,  in  normal  conditions,  the  will  possesses  over  the 
reflex  faculty.  The  base  of  the  encephalon,  and  especially  the 
medulla  oblongata,  is  the  most  frequent  seat  of  the  increase  in  the 
reflex  excitability,  so  that  this  part  of  the  nervous  centre  is  the 
ordinary  seat  of  epilepsy.  The  disturbance  in  the  functions  of  the 
cerebral  lobes,  during  and  immediately  after  a  fit,  and  in  the  inter- 
paroxysmal  periods,  is  chiefly  due  to  the  alterations  taking  place  in 
the  brain  during  the  fits.  This  hitherto  mysterious  coincidence  of 
loss  of  consciousness,  or,  in  other  words,  loss  of  the  function  of  the 
cerebral  lobes,  with  an  increased  action  of  the  base  of  the  encepha- 
lon, in  a  complete  epileptic  seizure,  may  now  be  easily  explained. 
I  have  tried  to  show  that  the  same  cause  that  produces  the  first 
convulsions  in  some  muscles  of  the  neck,  the  eye,  the  larynx,  and 
the  face,  produces  also  a  contraction  of  the  bloodvessels  of  the  brain 
proper,  which  contraction  is  necessarily  followed  by  the  loss  of 
consciousness.  I  am  happy  to  state  that  two  very  able  German 
experimenters — Messrs.  Kussmaul  and  Tenner,1  led  by  researches 
in  several  respects  different  from  mine,  have  arrived  at  the  same 
explanation. 

In  reviewing  the  principal  phenomena  of  a  complete  seizure  of 
epilepsy,  we  find  that  they  form  a  series  of  causes  and  effects,  as 
shown  in  the  following  table: — 


Causes. 

1.  Excitation  of  certain  parts  of  the 
excito-motory  side  of  the  nervous  centre. 

2.  Contraction  of  the  bloodvessels  of 
the  brain  proper. 

3.  Extension  of  the  first  excitation, 
partly  due  to  the  accumulation  of  blood 
in  the  base  of  the  encephalon. 


Effects. 

1 .  Contraction  of  bloodvessels  of  the 
brain  proper  and  of  the  face,  spasm  of 
some  muscles  of  the  eye  and  face. 

2.  Loss  of  consciousness,  and  accumu- 
lation of  blood  in  the  base  of  the  ence- 
phalon. 

3.  Tonic  contraction  of  the  laryngeal, 
the  cervical,  and  the  thoracic  expiratory 
muscles.  (  Laryngismus  and  trachelismus. ) 


1  Untersuchungen  zur  Naturlehre,  &c,  von  Moleschott,  vol.  iii.,  Part  I.,  1857. 
I  must  say  that  I  had  published  the  above  explanation  before  these  German  phy- 
siologists ;  but  they  have  arrived  at  it  quite  independently,  and  almost  at  the 
same  time  as  myself. 


184  THE    CENTRAL    NERVOUS    SYSTEM. 

Causes.  Effects. 

4.  Contraction  of  laryngeal  and  of  tho-  4.  Crying,  and  stoppage  of  respira- 
racic  expiratory  muscles.  tion. 

5.  Farther  extension  of  the  first  exci-  5.  Tonic  contraction,  extending  to 
tation  of  the  nervous  centre.  most  of  the  muscles  of  the  trunk  and 

limbs. 

6.  Loss   of   consciousness,   and   tonic        6.  Falling, 
contraction  in  the  trunk  and  limbs. 

7.  Laryngismus,  trachelismus,  and  7.  Asphyxia,  with  obstacles  to  the  re- 
the  fixed  state  of  the  chest.  turn  of  venous  blood  from  the  head  and 

the  spinal  cavity. 

8.  Asphyxia,  and  the  accumulation  of        8.  Clonic  convulsions  everywhere  ;  con- 
black  blood  in  the  encephalon,  and  in    tractions  of  the  bowels,  the  bladder,  the 
the  spinal  cord.  j  uterus  ;  erection ;  increase  of  many  se- 
cretions ;  efforts  at  inspiration. 

9.  Exhaustion  of  nervous  power  gene-  !  9.  Cessation  of  the  convulsions  ;  coma 
rally,  and  of  the  reflex  faculty  especially,  or  heavy  sleep,  after  which  extreme  fa- 
except  for  respiration,  which  gradually    tigue  and  headache. 

becomes  normal. 

Of  course  this  table  shows  only  the  most  frequent  filiation  of 
phenomena,  and  it  is  useless  to  say  that  there  are  great  varieties  as 
regards  the  first  phenomena.  The  admirable  researches  of  Dr. 
Marshall  Hall  have  shown  how  important  are  the  laryngismus  and 
trachelismus,  in  the  causation  of  the  epileptiform  convulsions.  I 
will  only  add  that  the  asphyxia,  to  which  so  great  a  share  is  due 
in  the  phenomena  of  epilepsy  and  in  its  most  grave  consequences, 
depends  not  only  upon  the  state  of  the  larynx,  but  on  that  of  the 
chest;  and  that,  not  only  the  blood  cannot  return  easily  from  the 
head,  on  account  of  the  trachelismus,  but  also  it  cannot  enter  the 
chest  from  either  the  spinal  canal  or  the  head,  on  account  of 
the  fixed  state  of  expiration.  Besides,  the  bronchia?  themselves 
are  often  contracted;  and  all  these  causes  coexist  with  an  increased 
production  of  carbonic  acid,  and  with  a  change  in  the  circulation 
of  the  encephalon,  during  which  the  blood  accumulates  in  the  base 
of  this  organ,  and  also  in  the  spinal  cord. 

As  regards  the  treatment  of  epilepsy,  we  will  only  say  that  the 
principal  rule  is  to  find  out  if  the  disease  has  an  external  cause — 
i.  e.,  if  from  any  part  of  the  centripetal  nerves  there  is  an  irritation 
acting  upon  the  nervous  centres.  To  prevent  this  irritation  reach- 
ing these  centres,  or  to  destroy  the  cause  of  this  irritation,  if  it  is 
known  to  exist,  are  the  two  things  to  be  done.  I  must  repeat  that 
this  will  be  found  much  more  often  than  is  generally  supposed. 
Against  the  increased  excitability  of  some  part  of  the  nervous  cen- 


CASE    OF    CONVULSIONS    AND    INSANITY.  185 

tres,  the  best  means,  assuredly,  are  the  powerful  modificators  of 
nutrition,  which,  I  am  sorry  to  say,  are  so  little  employed  by  regu- 
lar practitioners — the  cauterization  of  the  back  of  the  neck  by 
moxas,  or  by  the  red-hot  iron. 

Other  affections  very  often  have  the  same  characteristic  features 
as  epilepsy,  as  regards  their  production.  If  I  had  time,  I  could 
relate  a  very  large  number  of  facts  to  prove  that,  much  more  fre- 
quently than  might  be  imagined  by  most  of  my  hearers,  the  various 
forms  of  insanity,  of  vertigo,  of  hallucinations,  and  of  illusions,  and 
also  extasis,  catalepsy,  hysteria,  chorea,  hydrophobia,  tetanus,  local 
cramps,  and  even  the  general  paralysis  connected  with  insanit}^, 
may  be  due  to  irritations  starting  from  a  centripetal  nerve,  and 
frequently  slightly  felt,  or  even  unfelt;  and  that  the  suppression  of 
these  irritations  may  promptly  cure  the  patient,  just  as  in  cases  of 
epilepsy.  Instead  of  a  description  of  this  kind  of  affection,  I  will 
give  here  a  case  which  is  full  of  interest,  and  which  I  owe  to  the 
kindness  of  Mr.  Campbell  de  Morgan,  who  had  received  it  from  the 
late  Mr.  Standert,  of  Taunton,  who,  according  to  Mr.  de  Morgan,  was 
one  of  the  most  original  thinkers  and  best  surgeons  of  his  day  : — 

Case  44. — On  rising  in  the  morning,  a  lad,  fourteen  years  old,  was 
heard  by  his  father  making  a  great  disturbance  in  his  bed-room, 
who,  rushing  in  to  know  the  cause,  found  his  son  in  his  shirt, 
violently  agitated,  speaking  incoherently,  and  breaking  to  pieces 

the  furniture.     Mr. caught  the  lad  in  his  arms,  and  threw  him 

back  on  the  bed,  when  he  at  once  became  composed,  but  did  not 
seem  conscious  of  the  mischief  he  had  done.  He  said  that  on 
getting  out  of  bed  he  had  felt  something  odd,  but  that  he  was  very 
well,  and  thought  that  he  might  have  had  a  frightful  dream,  although 
he  could  not  recollect  it.  I  was  immediately  sent  for,  and  the  lad 
ordered  to  remain  in  bed  until  I  had  seen  him.  About  five  hours 
after,  I  found  the  lad  lying  in  bed,  reading  some  amusing  book; 
his  tongue  clean,  pulse  regular,  countenance  calm  and  cheerful.  He 
said  he  was  quite  well,  and  wished  to  get  up,  but  that  his  father 
had  ordered  him  to  remain  in  bed  until  I  had  seen  him.  I  was  in- 
formed, before  I  went  up  to  his  bed-room,  that  the  lad  had  never 
before  been  heard  to  complain  of  disturbed  dreams,  or  walked  in 
his  sleep,  or  exhibited  any  epileptic  symptoms,  and  that  his  general 
health  had  been  good,  and  all  his  functions  regular.  Finding  the 
patient  free  from  any  apparent  disease,  and  that  he  had  eaten  with 
good  appetite,  and  no  disturbance,  his  usual  breakfast,  I  desired 


13o  THE    CENTRAL    NERVOUS    SYSTEM. 

him  to  get  up.  When,  sitting  up  in  his  bed,  he  drew  on  his  stock- 
ings; but  on  putting  his  feet  on  the  floor  and  standing  up,  his  counte- 
nance instantly  changed,  the  jaw  became  violently  convulsed,  and  he  was 
about  to  rush  forward,  when  I  seized  and  pushed  him  back  on  the 
bed.  He  was  at  once  calm,  but  looked  surprised,  and  asked  what 
was  the  matter  with  him.  He  assured  me  that  he  had  felt  no  pain, 
had  slept  well,  but  that  he  ufelt  odd"  when  he  stood  up.  I  found 
that  he  had  been  fishing  on  the  preceding  day,  and,  having  en- 
tangled his  line,  had  taken  off'  his  shoes  and  stockings,  and  waded 
into  the  river  to  disengage  it;  but  he  said  he  had  not  cut  or 
scratched  his  feet  or  met  with  any  other  accident.  To  ascertain 
this  point,  I  made  him  draw  off  his  stockings,  and  examined  his 
legs  minutely.  Not  the  slightest  scratch  or  injury  could  be  seen; 
but  on  holding  up  the  right  great  toe  with  my  finger  and  thumb  to  ex- 
amine the  sole  of  that  foot,  the  leg  was  drawn  up,  and  the  muscles  of  the 
jaws  were  suddenly  convulsed,  and  on  releasing  the  toe  these  effects  in- 
stantly ceased.  I  then  closely  inspected  the  toe.  The  nail  was  per- 
fect; there  was  not  the  least  swelling  or  redness  in  the  surrounding 
parts,  nor  any  tenderness  or  uneasiness  felt  when  I  compressed  the 
toe  laterally,  or  moved  it,  held  thus,  in  any  direction;  but  on  the 
bulb  of  the  toe,  nearly  at  the  point  where  the  circumgyrations  of 
the  cuticle  centre,  there  was  a  very  small  elevation,  as  if  a  bit  of 
gravel,  less  than  the  head  of  a  small  pin,  had  been  there  pressed  in 
beneath  the  cuticle.  There  was  not  the  least  redness  on  this  spot, 
nor  any  sensation  or  effect  produced  by  passing  rny  finger  over  its 
surface;  but  on  compressing  it  with  ?ny  finger  and  thumb  against  the 
nail  very  cautiously,  a  slight  convulsion  instantly  ensued.  I  asked  the 
patient  if  anything  pricked  him?  He  said  "No,  but  something  made 
him  feel  very  odd."  On  examining  the  part  well  with  a  pocket  lens, 
no  scratch  or  puncture  of  the  cuticle  could  be  discerned.  I  then  with 
a  pair  of  scissors  included  and  snipped  away  the  slightly  elevated 
part,  but  not  so  deeply  as  to  denude  the  cutis  beneath.  In  the  bit 
of  cuticle  thus  removed  I  expected  to  find  some  point  of  a  thorn  or 
particle  of  sand,  but  could  not  detect  anything  of  the  kind.  I  then 
pressed  the  toe  in  every  direction ;  the  strange  sensation  was  gone, 
and  never  returned. 

I  do  not  know  that  any  member  of  the  patient's  family  had  ever 
been  under  treatment  for  insanity,  but  two  of  his  uncles  and  I 
believe  an  aunt  were  suicides,  and  the  patient  himself,  many  years 
afterwards,  was  "found  drowned"  by  the  cautious  verdict  of  an  in- 
quest.    " 


187 


LECTUEE  XII. 

ON  THE  MEDULLA  OBLONGATA,  THE  PONS  VAROLII,  AND  SOME  PARTS 
OF  THE  SPINAL  CORD,  IN  THEIR  RELATIONS  WITH  RESPIRATORY  MOVE- 
MENTS ;  WITH  VERTIGINOUS  OR  ROTATORY  CONVULSIONS  ;  WITH  THE 
TRANSMISSION  OF  SENSITIVE  IMPRESSIONS  AND  OF  THE  ORDERS  OF 
THE  WILL  TO  MUSCLES,  AND  WITH  THE  VASO-MOTOR  NERVES  AND 
ANIMAL  HEAT.— GENERAL  CONCLUSIONS  OF  THE  COURSE. 

Medulla  oblongata  erroneously  considered  as  the  source  or  focus  of  life. — Causes 
of  death  in  cases  of  sudden  injury  to  this  organ. — Respiration  depending  upon 
other  parts  of  the  cerebro-spinal  axis,  besides  the  medulla  oblongata. — Causes 
of  the  cessation  of  respiration  in  cases  of  a  complete  section  of  the  medulla 
oblongata. — How  are  the  respiratory  movements  produced  ? — Parts  of  the  ence- 
phalon  and  spinal  cord  that  may  produce  rotatory  convulsions. — Causes  of  the 
vertiginous  or  rotatory  convulsions. — The  auditory  nerve  and  its  power  of  pro- 
ducing partial  or  general  convulsions. — The  olivary  and  restiform  columns  of 
the  medulla  oblongata  and  their  relations  with  various  nervous  disturbances. — 
Reasons  against  the  view  that  the  fibres  which  decussate  all  along  the  median 
line  of  the  base  of  the  encephalon  are  voluntary  motor  fibres. — Reasons  for 
admitting  that  the  anterior  pyramids  contain  nearly  all  the  voluntary  motor 
fibres  of  the  body. — Three  kinds  of  paralysis  due  to  lesions  in  three  different 
parts  of  the  cerebro-spinal  axis. — Anaesthesia  and  hyperesthesia  in  their  rela- 
tions with  the  state  of  bloodvessels  and  the  degree  of  animal  heat. — Condition 
of  voluntary  movements,  sensibility,  and  animal  heat,  in  different  cases  of 
alteration  of  the  central  nervous  system. — General  conclusions. 

Mr.  President  and  Gentlemen  :  Since  the  time  of  Galen1  most 
of  the  physiologists,  and  particularly  Lorry,  Cruikshank,  Lorenz, 
Bartels,  and  Legallois,  have  ascertained  that  a  sudden  and  deep 
injury  to  the  lower  part  of  the  medulla  oblongata,  in  animals,  causes 
immediate  death,  and  many  cases  observed  in  man  have  shown  the 
same  thing.  It  has  been  almost  universally  admitted  that  death 
is  then  due  to  the  fact  that  respiration  ceases  because  the  lower 
part  of  the  medulla  oblongata  is  the  centre  for  respiratory  move- 
ments.    But  if  we  study  carefully  what  takes  place  in  most  of  the 

1  Galen  clearly  states  that  a  section  of  the  medullary  axis,  beneath  the  first  or 
the  second  cervical  vertebra  in  an  animal,  kills  it  at  once.  See  De  Anat. 
Administr.,  lib.  8,  cap.  9,  pp.  696,  697.     Kuhn's  ed.,  Leipzig,  1821. 


188  THE    CENTRAL    XERVOUS    SYSTEM. 

cases  of  immediate  death  caused  by  a  sudden  and  deep  injury  to 
the  lower  part  of  the  medulla  oblongata,  we  find  that  it  is  impos- 
sible to  explain  this  curious  mode  of  death  by  admitting  that  it  is 
only  due  to  a  sudden  arrest  of  respiration. 

If  we  take  two  living  animals  of  the  same  species,  and  decapitate 
them  by  a  section  passing,  in  one  of  them,  on  the  nib  of  the  cala- 
mus scriptorius,  and  in  the  other,  on  the  fourth  or  fifth  cervical 
vertebra,  and  cutting  also,  in  both,  the  principal  nerves  of  the  neck, 
and  avoiding  the  section  of  the  carotids,  we  often  find  that  the  first 
one  has  no  convulsions,  or,  in  other  words,  no  agony ;  while  the 
second  almost  always  has  very  violent  convulsions  in  the  four 
limbs  and  in  the  trunk.  In  both  cases  the  medulla  oblongata  is 
taken  away  and  respiration  is  stopped ;  we  cannot,  therefore,  attri- 
bute to  the  cessation  of  respiration  the  absence  of  convulsions  in 
only  one  of  the  cases.  We  will  see  in  a  moment  what  is  the  cause 
of  this  absence  of  convulsions.  Before  we  come  to  this  explanation, 
we  must  say  that  a  physiologist  who  has  attained  a  very  high 
situation  in  France,  M.  Flourens,  one  of  the  perpetual  secretaries 
of  the  Academy  of  Sciences,  to  explain  the  sudden  death  after  the 
destruction  of  a  small  part  of  the  medulla  oblongata,  has  proposed 
a  theory  of  which  we  ought  to  take  notice,  on  account  of  the  stand- 
ing of  its  author.  M.  Flourens  imagines  that  life  depends  on  a 
force  springing  from  a  very  small  part  of  the  medulla  oblongata, 
which  small  part  he  calls  the  vital  point  or  the  vital  knot} 

If  this  hypothesis  were  true,  certainly  it  would  be  very  easy  to 
understand  why  there  are  no  convulsions,  and  hardly  any  sign  of 
life  in  the  heart  and  in  other  organs  after  the  extirpation  or  de- 
struction of  the  pretended  vital  knot.  Unfortunately  for  this 
theory,  the  part  which  is  supposed  to  be  the  focus  or  the  source  of 
life  may  be  taken  away,  and  life  persist,  without  any  marked 
trouble.  My  experiments  not  only  show  that  life  may  last  long 
after  the  extirpation  of  a  much  larger  part  of  the  medulla  oblongata 

1  The  paper  of  M.  Flourens,  containing  his  principal  assertions  in  this  respect  is 
in  the  Comptes  Rendus  de  VAcad.  des  Sciences,  vol.  xxxiii.,  1851,  p.  437.  He 
declares  that  the  vital  knot  is  not  larger  than  the  head  of  a  pin,  and  that  its  place 
is  at  the  point  of  the  small  V  of  gray  matter,  at  the  nib  of  the  calamus  scriptorius. 
Forgetting  all  that  he  had  said  as  regards  the  size  of  this  small  point,  M.  Flourens 
has  just  read  a  paper  to  the  Academy  of  Sciences  (Comptes  Rendus,  1858,  vol. 
xlvii.  p.  803),  in  which  he  acknowledges  that  the  extirpation  of  that  small  point 
does  not  destroy  life,  and  he  now  places  the  vital  knot  in  the  midst  of  the  medulla 
oblongata,  between  the  V  of  gray  matter  and  the  crossing  of  the  anterior  pyramids. 


CAUSES    OF    THE    CESSATION    OF    EESPIKATION.  189 

than  this  small  amount  of  gray  matter  erroneously  considered  as 
the  source  of  life,  but  that  neither  any  part  nor  the  whole  of  the 
oblong  medulla  can  be  considered  as  the  source  of  a  pretended  vital 
force.  In  the  first  place,  a  sudden  irritation  of  the  spinal  cord,  as 
well  as  that  of  the  medulla  oblongata,  may  cause  a  sudden  death, 
without  agony  or  convulsions,  although  in  both  cases,  and  especially 
in  the  first  one,  the  pretended  focus  of  life  remains  almost  or  entirely 
uninjured.  In  the  second  place,  the  extirpation  of  this  pretended 
only  source  of  life,  when  made  carefully  by  slow  and  partial  sec- 
tions, at  a  certain  distance  from  it  on  the  spinal  cord  and  the  pons 
Varolii,  is  followed  by  the  most  violent  convulsions  and  by  ener- 
getic movements  of  the  heart,  the  bowels,  the  bladder,  &c.  In  the 
third  place,  if  the  par  vagum  has  been  divided  in  a  living  animal, 
any  kind  of  operation  may  be  performed  upon  the  medulla  oblon- 
gata without  destroying  quickly  or  suddenly  the  movement  of  the 
heart ;  and,  in  this  case,  the  convulsions  of  agony  take  place  with 
energy. 

From  the  above-mentioned  facts  and  from  several  others,  I  have 
drawn  the  conclusions1  that  the  irritation  of  the  oblong  medulla 
and  of  some  parts  of  the  spinal  cord  (a  great  portion  of  the  cervical 
region)  is  able  to  produce  a  sudden  stoppage  or  diminution  of  the 
movements  of  the  heart,  and  that  it  is,  in  a  great  measure,  to  this 
influence  on  the  heart  that  is  due  the  absence  of  agony  in  most  of 
the  cases  of  sudden  destruction  of  the  oblong  medulla. 

More  than  ten  years  ago,  I  found  that  certain  animals  may  live 
for  many  weeks,  and,  in  more  recent  researches,  for  eight  months, 
after  the  extirpation  of  the  whole  medulla  oblongata.3  In  these 
animals  all  the  functions  of  organic  life,  except  pulmonary  respira- 
tion, continue  without  any  apparent  alteration,  showing  that  these 
functions  do  not  depend  upon  the  medulla  oblongata,  as  some 
physiologists  have  thought.  The  persistence  of  life  in  these 
animals  was  possible  on  account  of  the  cutaneous  respiration;  but 
in  animals  in  which  the  skin  absorbs  but  a  small  amount  of  oxygen, 
such  as  birds  and  mammals,  death  is  said  to  be  always  rapid  after 
the  extirpation  of  the  medulla  oblongata,  even  when  care  is  taken 
to  avoid  the  influence  of  the  operation  upon  the  heart.     It  seems, 

1  See  my  paper,  Recherches  sur  les  Causes  de  Mort  apres  l'Ablation  du  Point 
Vital,  in  Journal  de  la  Physiol,  de  VHomme,  &c,  Avril,  1858,  pp.  217-233. 

2  Comptes  Rendus  de  l'Acad.  des  Sciences,  1847,  vol.  xxiv.  p.  363,  and  my 
Exper.  Researches  applied  to  Physiol,  and  Pathol.,  1853,  p.  40. 


190  THE    CENTRAL    NEBVOUS    SYSTEM. 

therefore,  that  the  medulla  oblongata  is  an  organ  absolutely  neces- 
sary to  respiratory  movements.  Against  this  view  I  will  remark, 
1st,  that  Dr.  Bennet  Dowler,  of  New  Orleans,  has  seen  thoracic 
respiratory  movements  continuing  in  decapitated  alligators;  2d, 
that  Dr.  B.  "W.  Richardson  has  observed  the  same  fact  in  young 
mammals;  3d,  that  I  have  seen  it  also  in  birds,  and  in  kittens  and 
puppies. 

It  seems,  therefore,  quite  certain  that  the  respiratory  movements 
do  not  depend  only  upon  the  medulla  oblongata.  I  have  already 
tried  to  show,  in  1851,  that  many  parts  of  the  encephalon  are  em- 
ployed in  respiration,  and,  since  then,  I  have  collected  a  great  many 
pathological  facts,  proving,  I  think,  the  correctness  of  this  view. 
It  is  known  that  the  only  two  appearances  of  proof  that  the  medulla 
oblongata  is  the  only  centre  of  respiratory  movements,  or,  in  other 
words,  the  only  source  (direct  or  reflex)  of  these  movements  in  the 
cerebro-spinal  axis,  are — 1st,  that  a  transversal  section  of  the  lower 
part  of  the  medulla  oblongata  causes  a  sudden  cessation  of  respira- 
tion ;  2d,  that  when  transversal  sections  are  made  on  the  encephalon, 
from  its  front  to  its  back,  taking  away  layer  after  layer,  it  is  said 
that  it  is  only  after  the  greatest  part  of  the  medulla  oblongata  has 
been  taken  away,  that  respiration  is  destroyed.  As  regards  the 
first  of  these  two  assertions,  we  have  already  shown  the  objections 
against  it — objections  which  are  also  very  good  against  the  second 
assertion.  But  we  must  say  a  few  words  more  of  this  second  as- 
sertion. When,  after  a  series  of  transversal  sections  of  the  ence- 
phalon, we  have  reached  the  medulla  oblongata,  just  above  the 
upper  roots  of  the  par  vagum,  we  find  that  respiration  continues 
almost  normal.  If  now  we  cut  away  the  part  of  the  medulla  giving 
origin  to  this  pair  of  nerves,  we  find,  in  most  cases,  that  respiration 
is  suddenly  stopped.  This  certainly  seems  to  prove  that  the  small 
part  to  which  the  par  vagum  is  attached  is  the  nervous  centre  for 
respiration.  But  is  it  truly  so?  I  will  try  to  prove  that  it  is 
not. 

1st.  In  weak  animals,  after  many  parts  of  the  encephalon  have 
been  taken  away,  the  whole  of  the  medulla  oblongata  and  of  the 
pons  Varolii  remaining,  respiration  sometimes  continues  normal, 
but  it  suddenly  stops  after  a  small  part  of  the  pons  is  removed.  It 
would  be  wrong  to  draw  from  this  experiment  the  conclusion,  that 
this  small  part  is  the  central  organ  of  respiration.  To  draw  such 
a  conclusion,  however,  would  be  to  employ  the  same  reasoning 
which  has  been  adopted  concerning  the  part  of  the  medulla  oblon- 


gata  giving  origin  to  the  par  vagum.  The  stronger  an  animal  is, 
the  more  parts  of  its  encephalon  can  be  taken  away  before  we 
destroy  respiration.  It  is  in  animals  in  which  the  spinal  cord  is 
rich  in  gray  matter,  and  possesses  a  powerful  reflex  faculty,  that 
we  find  respiration  persisting  after  the  whole  of  the  encephalon, 
including  the  oblong  medulla,  has  been  extirpated ;  such  is  the 
case  in  alligators,  in  birds,  in  young  dogs  and  cats. 

2d.  In  the  strongest  animals,  death  occurs  in  a  few  hours,  and 
from  insufficiency  of  respiration,  after  the  ablation  of  the  encephalon 
except  the  whole  of  the  medulla  oblongata ;  and  so  it  often  is  with 
anencephalic  monsters.  These  facts  show  clearly  that,  although 
respiration  may  be  carried  on,  for  a  time,  almost  as  well  as  in  the 
normal  condition  of  the  central  nervous  system,  when  only  the 
medulla  oblongata  and  the  spinal  cord  exist,  these  organs  are  in- 
sufficient for  a  long  persistence  of  this  function.  A  series  of  ex- 
periments on  pigeons  has  given  me  the  following  results :  with  the 
spinal  cord  alone,  respiration  continues  a  few  minutes ;  with  the 
spinal  cord  and  the  part  of  the  oblong  medulla  giving  origin  to  the 
principal  excitors  of  respiration — the  vagi — this  function  continues 
many  hours  (the  longest  duration  we  have  seen  is  thirteen  hours); 
if  there  is  also  a  great  part  of  the  base  of  the  encephalon  left,  re- 
spiration continues  longer,  but  I  have  never  seen  it  last  more  than 
a  day  and  a  half;  if  the  cerebrum  alone  is  taken  away,  respiration 
remains  undisturbed ;  and  if  death  occurs,  it  is  not  on  account  of 
an  insufficiency  of  the  parts  left  of  the  cerebro-spinal  axis  to  carry 
on  respiration. 

3d.  In  man,  hemorrhage  in  the  various  parts  of  the  base  of  the 
encephalon,  near  the  median  line  or  upon  it,  produces  a  trouble  in 
respiration,  which  is  more  and  more  marked  the  greater  the  amount 
of  effused  blood,  and  the  nearer  it  is  to  the  medulla  oblongata. 
Certainly,  in  many  cases,  the  trouble  of  respiration  may  be  partly 
attributed  to  pressure  on  the  medulla  oblongata,  but  it  is  not  always 
so ;  and,  at  any  rate,  in  several  cases  of  softening  of  the  pons 
Varolii,  in  which  it  cannot  be  said  that  there  was  a  pressure  on  the 
oblong  medulla,  there  has  been  a  trouble  in  respiration.  From 
the  examination  of  a  great  many  cases,1 1  have  been  led  to  the 
conclusion  that  the  whole  base  of  the  encephalon  is  employed  in 
respiration. 

1  Most  of  these  cases  have  heen  published  in  the  thesis  of  my  pupil,  Dr.  J.  B. 
Coste,  Recherches  sur  le  Role  de  VEnctphale  dans  la  Respiration,  Paris,  1851. 


192  THE    CENTRAL    NERVOUS    SYSTEM. 

4th.  Many  cases  have  been  observed  in  which  the  medulla 
oblongata  has  been  so  much  altered  that  almost  all  its  actions  as  a 
nervous  centre  ought  to  have  been  destroyed,  and,  nevertheless, 
respiration  has  continued  to  take  place ;  in  those  cases  there  was 
still,  however,  a  more  or  less  free  communication  between  the  pons 
Varolii  and  the  spinal  cord,  and  probably  several  of  the  filaments 
of  the  par  vagum  continued  to  act  as  excitors  of  respiratory  move- 
ments. 

All  the  facts  just  mentioned,  and  many  others  of  which  I  have 
no  time  to  speak,  have  led  me,  first,  to  abandon  the  view  so  gene- 
rally admitted,  that  the  medulla  oblongata  is  the  essential  source  of 
the  respiratory  movements  in  the  nervous  centres ;  and  secondly, 
to  propose  the  view  that  these  movements  depend  upon  all  the 
incito-motory  parts  of  the  cerebro-spinal  axis,  and  on  the  gray 
matter  which  connects  those  parts  with  the  motor  nerves  going  to 
the  respiratory  muscles.  I  must  add  that,  according  to  the  theory 
I  have  arrived  at,  the  principal  cause  of  respiration  is  in  the  lungs, 
as  Dr.  Marshall  Hall  has  tried  to  prove ;  but  that  excitations  coming 
from  all  parts  of  the  body,  as  shown  by  Yolkmann  and  Yierordt, 
and  also  direct  irritations  of  the  base  of  the  encephalon  and  of  the 
spinal  cord,  almost  constantly  taking  place,  contribute  to  the  pro- 
duction of  respiratory  movements. 

I  pass  now  to  another  and  a  quite  different  subject,  although  it 
is  connected  with  the  physiology  and  pathology  of  the  parts  of  the 
nervous  centres  which  have  the  principal  share  in  respiration.  I 
wish  to  say  at  least  a  few  words  about  rotatory  or  vertiginous  move- 
ments. It  seems,  indeed,  wonderful  to  see  animals,  sometimes 
after  a  slight  puncture  of  some  part  of  the  encephalon  with  the 
point  of  a  needle,  turn  round,  just  like  a  horse  in  a  circus,  or  roll 
over  and  over  for  hours,  and  sometimes  for  days,  with  but  short 
interruptions.  The  same  phenomena  having  often  been  observed 
in  man,  I  think  it  may  prove  interesting,  if  not  useful,  to  point  out 
the  parts  of  the  encephalon  which  may  produce  vertiginous  or 
rotatory  convulsions.  The  convulsions  differ  a  great  deal,  accord- 
ing to  the  place  injured  and  the  depth  and  size  of  the  injury.  If 
we  suppose  that  the  right  side  of  the  encephalon,  in  the  places  I 
will  name,  has  been  injured,  we  find  that  the  animal  turns  or  rolls, 
and  that  in  the  first  case  the  side  on  which  it  turns  is  either  the 
left  or  the  right;  while,  if  it  rolls,  the  rolling  begins  either  by  the 
left  or  the  right  side. 


PARTS    THAT    MAY    PRODUCE    CONVULSIONS.  193 

Parts  producing  turning  or  rolling  after  an  injury  on  the  right  side. 

Turning  or  rolling  by  the  right  side.  Turning  or  rolling  by  the  left  side. 

1.  Anterior  part  of  the  optic  thalamus.    1.  Posterior  part  of  the  optic  thalamus. 
(Schiff.)  (Schiff.) 

2.  The  hind  parts  of  the   crus  cerebri.  t  2.  Some  parts  of  the  crus  cerebri,  near 
(Schiff.)  the  optic  thalamus.  (Brown-Sequard.) 

3.  The  tubercula  quadrigemina.  (Flou-  3.  Anterior  and    superior  parts  of  the 
rens.)  pons  Varolii. 

4.  Posterior  part  of  the  processus  cere- ;  4.  Anterior  part  of  the  processus  cere- 
belli  ad  pontem.   (Magendie.)              .  belli  ad  pontem.   (Lafargue.) 

5.  Place  of  insertion  of  the  auditory  and  5.    Place    of    insertion    of    the    glosso- 
of  the  facial  nerves.  (Brown-Sequard  pharyngeal  nerve.  (Brown-Sequard.) 
and  Martin-Magron.) 

6.  Neighborhood  of  the  insertion  of  the  6.  Spinal  cord,  near  the  oblong  medulla, 
lower  roots  of  the  par  vagum.  (Brown-  (Brown-Sequard.) 

Sequard.) 

While  rotation  takes  place,  it  is  easy  to  ascertain,  1st,  that  it  is 
not  its  production  by  contractions  resembling  those  of  voluntary 
movements  which  causes  the  rolling  or  the  turning;  2d,  that  some 
muscles  are  in  a  state  of  tonic  contraction ;  3d,  that  the  trunk  and 
neck  of  the  animal  are  bent  by  a  spasmodic  action  on  the  side  of 
turning  if  it  has  a  circus  movement,  and  that  it  is  bent  like  a  cork- 
screw, as  much  as  the  bones  allow,  in  cases  of  rolling ;  4th,  that 
sensibility  and  volition  may  remain,  and  that  there  are  frequent 
efforts  to  resist  the  tendency  to  turn  or  roll.  It  seems  clear  from 
these  observations  and  several  others,  that  these  rotatory  move- 
ments depend  chiefly  upon  the  fact  that  certain  muscles  are  in  a 
state  of  spasm. 

I  shall  not  try  to  show  that  the  theories  of  Magendie,  of  Flourens, 
and  of  Longet,  are  in  opposition  with  many  of  the  particularities 
of  the  experiments.1  Any  one  knowing  these  theories  may  find 
out  from  the  above  statement  of  facts,  that  these  hypotheses  are 
not  acceptable.  The  theory  of  Henle,  who  admits  that  convulsions 
are  produced  in  the  eyes,  and  that  as  a  consequence  a  kind  of 
vertigo  is  generated,  which  causes  the  rotatory  movements,  is  not 
more  acceptable,  as  there  are  some  cases  in  man,  and  many  in 
animals,  in  which  the  eyes  had  no  convulsions  at  all,  although 
rotation  existed.  My  friend,  Dr.  Lebret,  has  seen  a  case  of  this 
kind  in  man.     That  a  state  of  vertigo  may  sometimes  be  the  prin- 

1  See  my  Experimental  Researches  on  Physiology  and  Pathology,  1853,  p.  18. 

N 


194  THE    CENTRAL    NERVOUS    SYSTEM. 

cipal  cause  of  turning  or  rolling,  is,  I  think,  beyond  question  ;! 
and  that  this  state  may  be  induced  either  by  the  irritation  of  some 
vaso-motor  nerve  in  the  encephalon,  or  by  the  too  great  attraction 
of  blood  by  some  parts  of  this  organ,  is,  I  think,  also  very  pro- 
bable; but  I  believe  that  in  most  cases  the  principal  cause  is  in  the 
irritation  of  a  peculiar  set  of  nerve-fibres  not  usually  employed  by 
the  will — nerve-fibres,  the  division  of  which  is  not  followed  by 
paralysis,  although  they  are  able  to  act  on  muscles  to  produce 
contractions,  and  even  more  powerful  than  those  caused  by  nerve- 
fibres  employed  by  the  will  in  voluntary  movements.  It  is  a  fact 
worthy  of  attention,  that  a  puncture  with  a  needle  through  the 
anterior  pyramids  which  contain,  as  I  will  soon  prove,  very  nearly 
all,  if  not  all,  the  nerve-fibres  employed  in  voluntary  movements, 
will  hardly  produce  a  momentary  contraction  in  some  muscles  ; 
while  certain  punctures  through  the  olivary  column  of  the  medulla 
oblongata  at  once  produce  a  spasm  of  many  muscles,  although  this 
column  does  not  contain  more  than  very  few  (if  any  at  all)  voluntary 
motor-fibres !  And,  now,  to  add  to  the  strangeness  of  the  fact,  in 
this  last  case,  the  muscles  remain  contracted  sometimes  for  hours, 
sometimes  for  days  and  weeks !  We  have  all  been  taught,  and 
several  probably  in  this  room,  where  there  are  so  many  professors 
and  lecturers,  have  taught  that,  after  the  removal  of  a  cause  of  ex- 
citation in  the  nervous  centres,  as  well  as  in  the  nerves,  the  effects 
of  the  excitation  disappear  until  inflammation  supervenes  and  pro- 
duces a  permanent  excitation ;  while  here,  however,  we  see  a  punc- 
ture with  a  needle  or  a  section  with  a  knife,  before  any  inflammation 
can  have  begun,  followed  by  a  persistent  effect.  There  is,  therefore, 
in  some  parts  of  the  nervous  centres,  a  property  of  acting  in  a 
persistent  manner  to  produce  muscular  spasms,  during  and  after  a 
mechanical  excitation. 

The  persistent  spasmodic  contractions,  due  to  a  mechanical  in- 
jury to  certain  parts  of  the  nervous  centres,  are  always  curious, 
but  never  so  much  so  as  when  they  result  from  some  irritation  of 
a  part  like  the  auditory  nerve,  which  we  were  accustomed  to  con- 
sider simply  as  a  nerve  of  sense.  M.  Flourens2  has  found  that  the 
section  of  the  semicircular  canals,  in  certain  animals,  is  followed 
by  a  strange  disorder  of  movements,  and  sometimes  by  a  rotation 

1  See  the  very  able  and  learned  paper  of  Dr.  Russell  Reynolds,  entitled  Vertigo. 
London,  1854. 

2  Rech.  sur  les  Propr.  et  les  Fonctions  du  Syst.  Nerveux.  2de  ed.,  1842,  p.  454 
et  seq. 


CAUSES    OF    ROTATORY    CONVULSIONS.  195 

(circus  movement).  I  have  ascertained  that  the  phenomena  ob- 
served in  these  experiments  do  not  depend  on  the  section  of  these 
canals,  as  this  operation  may  not  cause  these  phenomena,  but  that 
they  are  the  results  of  an  irritation  of  the  auditory  nerve,  from  the 
drawing  upon  it  by  the  membranous  semicircular  canals  at  the 
time  we  divide  them.  In  frogs  and  in  mammals,  the  direct  irrita- 
tion of  the  auditory  nerve  is  followed  by  the  most  interesting 
phenomena.  It  is  well  known  that  in  frogs  the  peripheric  ex- 
tremity of  this  nerve  is  inclosed  in  a  bag  containing  carbonate  of 
lime ;  as  soon  as  this  bag  is  laid  bare  and  slightly  touched,  and 
still  more  if  it  be  punctured  with  a  needle  or  a  bistoury,  the  ante- 
rior limb,  on  the  opposite  side,  is  thrown  into  a  state  of  slight  con- 
vulsion, and  kept  almost  constantly  in  a  spasmodic  pronation ;  and 
almost  at  every  attempt  to  move  forwards  the  animal  turns  round 
on  the  side  injured.  As  long  as  it  lives  (many  days,  or  even  many 
months),  these  phenomena  may  be  observed,  although  not  quite  so 
marked  as  immediately  after  the  injury,  or  after  the  first  twenty- 
four  hours.  In  mammals,  the  least  puncture  of  the  auditory  nerve 
causes  rolling,  just  as  after  the  irritation  of  the  processus  cerebelli 
ad  pontem ;  violent  convulsions  then  occur  in  the  eyes,  the  face, 
and  many  muscles  of  the  neck  and  chest.  The  doctrine  that  the 
nerves  of  the  higher  senses  are  not  endowed  with  general  sensi- 
bility (i.  e.,  are  not  able  to  cause  pain)  seems  not  to  be  true  with 
regard  to  the  acoustic  nerve ;  at  least,  the  signs  of  pain  given  after 
an  irritation  of  this  pretended  nerve  are  often  as  great  as  those 
observed  after  an  irritation  of  the  trunk  of  the  trigeminal  nerve. 

In  man,  also,  the  auditory  nerve  seems  to  be  able  to  act  as  it 
does  after  an  injury  in  animals. 

1st.  Any  one  who  has  received  an  injection  of  cold  water  in  the 
ear  may  know  that  it  produces  a  kind  of  vertigo,  and  that  it  is  diffi- 
cult to  walk  straight  for  some  time  after  this  irritation. 

2d.  A  sudden  noise  makes  the  whole  body  jump,  particularly  in 
old  people,  or  in  persons  attacked  with  anaemia,  chlorosis,  epilepsy, 
chorea,  hysteria,  hydrophobia,  and  in  certain  cases  of  poisoning; 
in  a  word,  in  all  circumstances  in  which  the  control  of  the  will  over 
reflex  actions  is  lost  or  diminished. 

3d.  Yertigo  and  various  convulsive  movements,  in  cases  of  irri- 
tation of  the  acoustic  nerve,1  have  been  observed  in  adults  and 

1  Walter  and  Lincke,  quoted  by  Harless  in  art.  "  Horen,"  in  Wagner's  Hand- 
worterbucli  der  Physiol.,  vol.  iv.,  1853,  pp.  420,  423. 


196  THE    CENTRAL    NERVOUS    SYSTEM. 

children.  Rotatory  movements  have  taken  place  in  cases  of  sup- 
purative inflammation  of  the  ear,  and  twice  immediately  after  an 
injection  of  a  solution  of  nitrate  of  silver.1  Quite  recently  Mr. 
Hinton  has  read  a  paper  to  one  of  the  London  medical  societies, 
in  which  he  relates  several  cases  of  convulsions  in  children,  without 
any  other  visible  alteration  after  death,  except  in  the  ear. 

I  could  point  out  several  other  facts  to  prove  that  irritation  of 
the  auditory  nerve  may  cause  vertigo,  rotatory  movements,  and 
various  other  kinds  of  convulsions;  but  I  think  I  have  said  enough 
to  call  the  attention  of  practitioners  to  this  subject,  and  this  was 
my  principal  object.  I  will  only  add  a  few  words  more  to  say  that 
the  causes  of  rotatory  movements  are  numerous,  and  that,  besides 
the  one  which  is  the  principal  in  most  cases  (and  that  is  the  spasm 
produced  in  some  muscles,  as  I  have  already  said),  there  is  a  cause 
similar  to  that  of  simple  vertigo,  depending  upon  anaemia,  or  gene- 
rated by  an  irritation  upon  some  centripetal  nerve  (as,  for  instance, 
in  cases  of  gastralgia),  and  producing  a  contraction  of  some  blood- 
vessels of  the  brain,  by  a  reflex  action,  and  this  cause  is  the  insuffi- 
ciency of  blood,  and  the  consequent  alteration  in  the  nutrition  of 
certain  parts  of  the  brain. 

The  parts  of  the  base  of  the  encephalon,  which  are  capable  of 
producing  persistent  spasms,  seem  to  be  quite  different  from  those 
employed  in  the  transmission  of  sensitive  impressions  or  of  the 
orders  of  the  will  to  muscles,  at  least  in  the  medulla  oblongata  and 
the  pons  Yarolii.  They  constitute  a  very  large  portion  of  these 
two  organs,  and  perhaps  the  three-fourths  of  the  first  one ;  they  are 
placed  chiefly  in  the  lateral  and  posterior  columns  of  these  organs; 
many  of  their  fibres  do  not  decussate,  and  produce  spasms  on  the 
corresponding  side  of  the  body;  they  seem  to  contain  most  of  the 
vaso-motor  nerves,  by  which,  directly  or  through  a  reflex  action, 
they  may  act  on  other  parts  of  the  nervous  system,  as  I  will  show 
hereafter;  they  have  much  to  do  with  the  phenomena  of  several,  if 
not  most,  of  the  convulsive  diseases  ;  and,  lastly,  I  will  say  that  the 
history  of  their  properties  and  actions  throws  a  great  deal  of  light 
on  the  effects  of  extirpation  or  diseases  of  the  cerebellum. 

The  above  assertions,  which  I  advance  with  the  greatest  reluc- 
tance, as  I  have  not  time  enough  to  show  that  they  are  based  on 

1  See  the  case  of  Prof.  Burggroeve,  recorded  by  himself  (Gaz.  Mid.  de  Paris, 
1842,  p.  25).  A  most  eminent  military  man,  I  am  told,  has  twice  been  seized  with 
rotatory  convulsions  after  injections  in  the  ear. 


RELATIONS    OF    COLUMNS    OF    MEDULLA    OBLONGATA.      197 

positive  and  numerous  facts,  are  not  the  only  ones  to  which  I  wish 
to  call  attention.  Connected  with  them  there  is  a  theory  of  which 
I  have  already  spoken  (see  Lecture  VII.),  and  which  I  must  now 
try  to  demonstrate.  This  theory  is,  that  almost  all,  if  not  all,  the 
voluntary  motor  fibres  of  the  trunk  and  limbs  that  come  from  the 
brain  pass  by  the  anterior  pyramids,  or  in  the  layer  of  gray  matter 
in  contact  with  them.  This  view,  which  is  pretty  nearly  the  one 
held  already  by  Mistichelli,  Pourfour  du  Petit,  and  others,  has  been 
universally  abandoned,  in  this  century,  after  the  publication  of  the 
important  researches  of  Foville1  and  of  Valentin,2  showing  that  there 
seems  to  be  a  complementary  decussation  of  nerve-fibres,  all  along 
the  median  line  of  the  base  of  the  encephalon. 

The  small  number  of  fibres  in  the  anterior  pyramids,  on  the  one 
hand,  has  appeared  to  be  insufficient  for  the  conveyance  of  the 
orders  of  the  will  to  all  the  muscles  of  the  trunk  and  limbs ;  and 
the  existence  of  paralysis  on  the  side  injured  in  the  encephalon, 
on  the  other  hand,  has  contributed  to  lead  to  the  actually  admitted 
opinion  that  the  voluntary  motor  fibres  make  a  part  of  their  decus- 
sation in  the  medulla  oblongata,  and  the  other  part  in  the  pons 
Varolii,  and  also  higher  up  between  the  two  sets  of  tubercula 
quadrigemina  and  the  two  cerebral  peduncles.  Long  ago  Cruveil- 
hier3  had  said  that  "  the  small  fascicles,  called  anterior  pyramids, 
cannot  be  sufficient  for  the  extensive  phenomena  indicating  a  cross- 
ing of  action  in  the  brain."  A  man  of  great  authority  in  physi- 
ology as  well  as  in  pathology,  Dr.  R.  B.  Todd,4  says  that  "  anatomy 
suggests  that  a  lesion  limited  to  either  anterior  pyramid  would 
affect  the  opposite  side  of  the  trunk,  for  it  is  known  that  such  an 
effect  follows  disease  of  the  continuation  of  it  in  the  meso-cephale 
or  crus  cerebri ;  and  that  lesion  limited  to  the  posterior  half  of 
the  medulla  oblongata,  on  either  side,  would  affect  the  same  side 
of  the  body,  no  decussation  existing  between  the  fibres  of  opposite 
restiform  or  posterior  pyramidal  bodies."  Longet,5  with  Foville 
and  Valentin,  expresses  the  idea  that  there  are  two  sets  of  voluntary 
motor  columns  in  the  medulla  oblongata :  one,  the  anterior  pyra- 
mids, and  the  other  the  olivary  or  innominated  columns;  and  that 

1  Traite  Complet  de  l'Anatomie  du  Syst.  Cerebro-Spinal,  1844,  pp.  298-326. 

2  Traite  de  Nevrologie,  Trad.  Franc.,  pp.  236,  237,  246. 

3  Article  "Apoplexie,"  in  "Diet,  de  Med.  et  de  Chir.  Prat.,"  vol.  iii.  p.  226. 

4  Art.  "Nervous  System,"  in  the  Cyclop,  of  Anat.  and  Physiol.,"  vol.  iii.  p. 
722.  T. 

5  Anat.  et  Physiol,  du  Syst.  Nerveux,  1843,  vol.  i.  p.  383. 


198  THE    CENTRAL    NEEVOUS    SYSTEM. 

this  last  set  has  a  decussation  of  fibres  all  along  the  pons  Varolii 
and  before  it.  (See  Fig.  24,  B,  B.)  Against  this  theory,  the  follow- 
ing decisive  arguments  may  be  advanced  : — 

1st.  Suppose  an  alteration  in  one  of  the  crura  cerebri.  (Fig.  25, 
p,  o.)  According  to  the  theory,  as  a  part  of  the  decussation  of 
the  voluntary  motor  nerve-fibres  takes  place  there,  we  should  find 
that  voluntary  movements  are  diminished  on  both  sides  of  the 
body — more,  of  course,  in  the  side  opposite  to  the  alteration,  but 
partly  also  in  the  same  side  of  the  body.  This  is  not  what  exists. 
One  side  only  of  the  body  is  paralyzed ;  and  it  is  the  opposite  side. 
A  number  of  cases  prove  that  this  is  the  rule.  The  hemiplegia 
may  be  complete  or  incomplete,  according  to  many  circumstances, 
and  particularly  the  extent  and  the  nature  of  the  alteration,  and  the 
rapidity  of  its  formation  ;  but  there  is  something  constant  coexist- 
ing with  any  one  of  these  numerous  varieties:  it  is  that  the  seat  of 
the  paralysis  is  in  the  side  of  the  body  opposite  to  that  of  the  dis- 
ease. It  is  evident,  in  consequence,  that  the  decussation  of  the 
voluntary  motor  nerve-fibres  has  entirely  taken  place  before  they 
reach  the  crura  cerebri. 

2d.  The  same  thing  may  safely  be  said  of  the  corpora  quadrige- 
mina.  (Fig.  18,  ?i,  t,  and  Fig.  24,  mn.)  Although  the  cases  relative 
to  these  organs  are  much  less  numerous  than  the  cases  relative  to 
the  crura  cerebri,  there  are  enough  of  them  on  record  to  prove 
that  the  crossing  of  the  voluntary  motor  nerve-fibres  must  have 
taken  place  entirely  before  they  reach  the  base  of  the  corpora 
quadrigemina.  Besides  some  other  cases,  there  are  two  very  in- 
teresting ones  which  have  been  published,  one  by  Mohr,  and  the 
other  by  Burnet — both  of  which  I  have  already  quoted. 

3d.  As  to  the  pons  Varolii  (Fig.  18,  p,  and  Fig.  25,  v),  the  ques- 
tion is  much  more  interesting,  because  this  is  the  place  where  the 
decussation  of  voluntary  motor  fibres,  according  to  Foville,  Valentin, 
and  Longet,  more  particularly  takes  place.  Here,  according  to  the 
theory  of  these  distinguished  anatomists,  we  ought  to  find  different 
symptoms  in  these  three  different  cases :  1st,  alteration  limited  to 
the  superior  part  of  the  organ ;  2d,  alteration  limited  to  the  infe- 
rior parts  (the  nearest  to  the  medulla  oblongata);  3d,  alteration 
occupying  the  whole  of  a  lateral  half  of  the  organ.  In  the  first 
case  we  should  see  an  incomplete  paralysis  in  both  sides,  but 
greater  on  the  side  of  the  body  opposite  to  the  side  of  the  disease; 
and,  in  the  second  case,  we  should  see  also  an  incomplete  paralysis 
in  both  sides,  and  almost  to  the  same  degree  in  both.     Many  cases 


THEOEY    OF    VALENTIN"    AND    OTHERS    DISAPPROVED.      199 

are  on  record  proving  that  it  is  not  so,  and  that  whatever  is  the 
part  of  the  pons  altered  (the  superior,  the  inferior,  or  the  middle), 
the  same  effect  is  produced  on  voluntary  movements.  When  para- 
lysis is  produced  by  the  lesion,  it  exists,  exclusively,  in  the  opposite 
side  of  the  body ;  and  when  the  alteration  is  not  limited  to  one 
side  of  the  pons,  and  extends  to  the  other,  then  the  side  most  para- 
lyzed in  the  body  is  the  one  opposite  to  the  most  altered  side  of  the 
pons. 

If  the  theory  of  Valentin,  Longet,  and  others  were  true,  we 
should  find  in  cases  where  the  whole  of  one-half  of  the  pons  is 
diseased,  the  two  sides  of  the  body  partly  paralyzed,  and  the  side 
opposite  to  the  alteration  less  than  the  other.  On  the  contrary, 
we  find  that  paralysis  exists  only  in  one  side,  and  that  is  the  one 
which,  according  to  the  theory,  should  be  less  paralyzed.  I  might 
prove  that  I  am  right  by  relating  here  many  pathological  facts; 
but  as  I  have  already  mentioned  some  (see  Lecture  VII.),  and  as  I 
shall  have  in  a  moment  to  mention  several  others,  I  will  merely 
now  affirm  again  that  there  are  many. 

4th.  Still  more,  if  the  theory  we  disapprove  were  true,  we  should 
see  in  cases  of  alteration  of  a  lateral  half  of  the  medulla  oblongata, 
above  the  decussation  of  the  anterior  pyramids  (Fig.  25,  jo,  a),  a 
paralysis  nearly  as  marked  in  the  same  half  of  the  body  as  in  the 
opposite  half.  But  this  is  not  what  is  observed,  and  we  find  para- 
lysis only  in  the  opposite  side.  (See  particularly  Cases  38  and  89, 
Lecture  VII.) 

It  seems  absolutely  certain,  from  the  above  facts  and  reasonings, 
that  there  is  no  decussation  of  the  voluntary  motor  fibres  of  the 
trunk  and  limbs  above  the  crossing  of  the  pyramids.  On  the  other 
hand,  we  have  already  shown,  in  a  previous  lecture,  that  there 
seems  to  be  no  decussation  of  these  fibres  in  the  spinal  cord — i.  e.} 
below  the  crossing  of  the  pyramids;  so  that  we  are  led  to  admit 
that  most  of,  if  not  all,  the  conductors  of  the  orders  of  the  will  to 
muscles  decussate  at  the  lower  part  of  the  medulla  oblongata,  and 
that  these  conductors  chiefly  form  the  anterior  pyramids,  after  their 
decussation.  An  interesting  fact,  in  addition  to  those  already  men- 
tioned, concerning  these  pyramids,  is,  that  when  a  lesion  exists  at 
the  place  of  decussation,  it  produces  a  paralysis  in  the  two  sides  of 
the  body,  because  it  destroys  fibres  belonging  to  them  both.  This 
is  a  feature  quite  peculiar  to  this  part  of  the  cerebro-spinal  axis. 
(See  Fig.  21—1,  2  and  3.) 

From  the  preceding  remarks,  and  from  the  facts  and  reasonings 


200  THE    CENTRAL    NERVOUS    SYSTEM. 

contained  in  our  lectures  (the  third  and  seventh)  on  the  decussation 
of  the  conductors  of  sensitive  impressions,  it  results  that,  as  regards 
anaesthesia  and  paralysis,  three  different  groups  of  symptoms  may 
be  observed,  according  to  the  place  of  the  alteration  in  a  lateral  half 
of  the  cerebro-spinal  axis :  1st,  above  the  decussation  of  the  pyra- 
mids, a  lesion  on  either  the  medulla  oblongata,  the  pons  Varolii, 
the  crura  cerebri,  the  optic  thalami,  the  corpora  striata,  or  the  brain 
proper,  if  it  produces  anaesthesia  and  paralysis,  produces  them  both 
in  the  opposite  side  of  the  body;  2d,  below  the  decussation  in  the 
pyramids,  a  lesion  in  the  spinal  cord  produces  paralysis  in  the  same 
side,  and  anaesthesia  in  the  opposite  side  ;  3d,  at  the  level  of  the 
decussation  of  the  pyramids,  and  upon  the  decussating  fibres,  and 
also  behind  them,  a  lesion  produces  paralysis  in  both  sides  of  the 
body,  and  anaesthesia  only  in  the  opposite  side.  So  that  wherever 
the  lesion,  in  a  lateral  half  of  the  cerebro-spinal  axis,  may  be — below, 
above,  or  at  the  level  of  the  crossing  of  the  pyramids — if  it  produces 
ancesthesia,  it  is  in  the  opposite  side;1  while  paralysis,  in  these  three  cases, 
is  either  in  the  same  or  the  opposite  side,  or  in  both  sides.  (See  Figs.  18 
and  21.) 

A  striking  proof  of  the  exactitude  of  the  view  that  the  anterior 
pyramids  are  almost  the  only  channels  for  the  orders  of  the  will  to 
muscles  in  the  medulla  oblongata,  and  that  the  olivary  or  interme- 
diate columns  have  no  share  in  this  function,  is  given  by  those  very 
interesting  cases  of  atrophy  of  one-half  of  the  brain  and  of  the 
corresponding  anterior  pyramid,  with  paralysis  and  atrophy  of  the 
two  limbs  of  the  opposite  side,  and  also  atrophy  of  the  opposite 
half  of  the  spinal  cord,  while  the  olivary  and  restiform  columns  are 
unaltered.  There  are  now  several  cases  of  this  kind  on  record;  I 
have  seen  two,  and  Mr.  Turner  has  given  a  complete  description  of 
three  or  four.2 

Many  persons  have  thought  that  the  cases  of  paralysis  depend- 
ing upon  an  alteration  in  a  lateral  half  of  the  encephalon,  and  ex- 
isting in  the  same  side  of  the  body,  could  not  be  accounted  for 
except  by  admitting  that  there  are  voluntary  motor  nerve-fibres 
that  do  not  decussate  in  the  medulla  oblongata.     I  have  not  time 

1  Of  course,  a  lesion  in  one-half  of  the  cerebro-spinal  axis,  anywhere  at  the  level 
of  the  entrance  of  a  sensitive  nerve,  besides  producing  anaesthesia  everywhere 
below  the  seat  of  the  injury  on  the  opposite  side,  causes  it  also  in  the  same  side, 
but  only  in  parts  receiving  the  nerve  or  nerves  the  roots  of  which  pass  through 
the  altered  part  of  the  nervous  centre. 

2  De  l'Atrophie  unilateral  du  Cerveau,  du  Cervelet,  &c.     These.     Paris,  1855. 


INCOMPLETE    PARALYSIS.  201 

enough  to  examine  fully  the  various  explanations  that  may  be  pro- 
posed about  paralysis  in  the  same  side  as  the  encephalic  lesion,  but 
I  will  try  to  show — 1st,  that  there  is  a  part  of  the  encephalon  which 
almost  always  produces  this  kind  of  paralysis ;  2d,  that  this  para- 
lysis ought  to  be  regarded  as  similar  to  the  reflex  paralysis  due  to 
an  irritation  of  centripetal  nerve-fibres,  in  any  viscus,  any  mem- 
brane, or  the  trunk  of  a  nerve.  (See  my  Journal  de  Physiol,  Juillet, 
1857,  p.  534.) 

When  a  tumor  exists,  pressing  upon  the  anterior  surface  of  one 
of  the  crura  cerebelli  and  upon  the  insertion  of  the  trigeminal 
nerve  (see  Fig.  25,  c  c),  if  it  causes  paralysis,  it  is  in  the  same  side 
of  the  body.  I  have  collected  fourteen  cases  of  this  kind,  all  having 
the  same  features,  which  are  incomplete  paralysis  in  the  side  of  the 
lesion,  no  anaesthesia  (except  in  one  case),  and  frequent  fits  of  vertigo. 
Now,  as  to  the  explanation  of  this  kind  of  paralysis,  we  will  say, 
that  it  is  either  the  result  of  the  destruction  of  some  conductors 
employed  in  voluntary  movements  (to  regulate  them  or  to  act  other- 
wise), or  of  the  irritation  of  certain  nervous  fibres  in  the  peduncle 
itself,  or  near  it.  Were  the  first  hypothesis  the  true  one,  we  should 
find  that  a  destruction  of  the  whole  peduncle  causes  paralysis  in 
the  corresponding  side  only,  or  in  it  and  in  the  other  one,  and  not 
in  this  other  alone;  but  there  are  several  cases  in  which  there  has 
been,  with  such  an  alteration,  a  paralysis  in  the  opposite  side  only.1 
We  should  find,  also,  that  alterations  of  the  parts  by  which  the  crus 
cerebelli  communicates  with  the  muscles  produce  a  paralysis  in  the 
same  side  of  the  body,  together  with  a  paralysis  in  the  opposite 
side.  But  this  is  not  what  is  observed.  I  have  collected  more  than 
thirty  cases  of  alteration  in  a  lateral  half  of  the  pons  Yarolii  and 
medulla  oblongata,  in  many  of  which  the  lesion  extended  to  the 
crus  cerebelli,  and  in  all  the  paralysis  was  in  the  opposite  side 
only.2  For  instance,  in  a  case  of  Dr.  Annan,  which  I  have  related 
(see  Case  38,  Lecture  VII.),  the  whole  connection  of  the  right  crus 
cerebelli  with  the  right  half  of  the  medulla  and  of  the  pons  was 
destroyed,  and  the  paralysis  existed  only  in  the  left  limbs.  (See 
Fig.  25,  c  c.) 

As  to  the  other  hypothesis,  we  will  say  that  it  is  the  only  one 

1  See  especially  a  case  carefully  recorded  by  Serres  (Traite  d'Anatomie  comparee 
du  Cerveau,  vol.  ii.  pp.  623-6). 

2  There  are  a  few  cases,  however,  in  which  a  tumor  has  pushed  backwards  and 
upwards  the  crus  cerebelli  and  the  corresponding  half  of  the  pons,  producing  only 
a  slight  degree  of  paralysis  in  the  same  side  of  the  body. 


202  THE    CENTRAL    NERVOUS)  SYSTEM. 

we  can  find  able  to  explain  the  production  of  the  paralysis  in  the 
side  injured,  in  cases  of  irritation  of  the  crus  cerebelli ;  and  we  will 
add  that,  perhaps,  the  same  explanation  would  be  the  right  one  for 
all  the  cases  of  the  so-called  direct  paralysis.  But  whether  it  is  the 
irritation  of  the  fibres  of  the  crus,  or  of  those  of  the  trigeminal 
nerve,  which  causes  the  paralysis,  we  cannot  tell,  and  we  have  no 
time  to  discuss  the  question.  The  same  reason  prevents  our  exa- 
mining why  the  anterior  surface  of  the  crus  cerebelli,  or  the  trige- 
minal nerve  at  its  point  of  insertion,  have  more  power  than  in  their 
other  parts,  or  than  the  rest  of  the  encephalon,  to  cause  a  paralysis, 
in  consequence  of  an  irritation.  I  will  only  say  that  we  find  that 
the  peripheric  parts  of  the  same  nerve  in  the  gums  and  the  bulbs 
of  the  teeth,  as  also  certain  parts  of  the  sympathetic  nerve,  have 
more  power  to  produce  a  paralysis  than  other  nervous  ramifications 
in  many  parts  of  the  body ;  and  that,  therefore,  there  is  no  ground 
for  an  objection  to  our  hypothesis  from  the  fact  that  such  a  para- 
lysis is  not  caused  by  the  irritation  of  other  parts  of  the  encephalon 
than  the  crus  cerebelli.  I  may  add,  that  when  an  irritation  on  a 
nerve  causes  a  paralysis,  it  is  usually  in  the  corresponding  side  of 
the  body  that  it  appears,  just  as  is  the  case  when  a  tumor  exists 
between  the  petrous  bone  and  the  crus  cerebelli. 

To  complete,  as  much  as  time  will  allow,  the  exposition  of  my 
views  on  the  physiology  and  pathology  of  the  central  nervous  sys- 
tem, I  have  now  to  speak  of  the  condition  of  animal  heat  in  cases 
of  alteration  of  the  spinal  cord  and  the  encephalon.  The  follow- 
ing conclusions  may  be  drawn  from  a  great  many  facts  bearing  on 
this  subject : — 

1st.  That  usually  anaesthesia  is  accompanied  by  a  diminution  of 
temperature. 

2d.  That  hyperesthesia  almost  always  co-exists  with  an  increased 
temperature. 

3d.  That  in  paralysis,  without  either  a  notable  hyperaesthesia  or 
anaesthesia,  the  temperature  is  nearly  normal. 

I  must  remark  that  the  state  of  heat  of  a  part  is  due  to  the 
amount  of  blood,  the  degree  of  heat  of  this  fluid,  the  exposure  of 
the  part  to  the  influence  of  the  temperature  of  the  surrounding 
medium,  and  the  temperature  of  this  medium.  Now,  in  anaesthetic 
parts  the  bloodvessels  are  usually  contracted,  and,  therefore,  there 
is  less  blood  in  them,  and  also  a  lower  temperature.  In  hyper- 
aesthetic  parts  the  reverse  exists. 

Pathological  cases  show  that  when  there  is  an  alteration  in  one- 


ANESTHESIA    AND    HYPERESTHESIA.  203 

half  of  the  spinal  cord,  the  bloodvessels  in  that  side  are  paralyzed, 
as  are  also  the  muscles.  There  is  more  blood  in  these  paralyzed, 
parts,  and  the  temperature  is  higher  than  it  is  normally.  In  the 
opposite  side  the  reverse  obtains.  It  seems  from  these  facts,  and 
from  many  experiments,  that  it  is  from  paralysis  of  the  vaso-motor 
nerves,  and  from  their  irritation  in  the  cerebro-spinal  axis,  that 
arises  the  difference  of  temperature  between  the  two  sides  of  the 
body,  in  cases  of  alteration  of  a  part  of  one-half  of  this  axis.  In 
combining  what  is  taught  by  pathological  cases,  as  regards  tempe- 
rature, with  the  symptoms  concerning  sensibility  and  voluntary 
movements,  we  are  led  to  give  the  following  indications  of  the  usual 
phenomena  to  be  observed  in  cases  of  disease  in  one  part  of  a 
lateral  half  of  the  cerebro-spinal  axis. 

Table  of  symptoms  in  the  trunk  and  limbs,  according  to  the  seat  of  a 
lesion  in  one  lateral  half  of  the  cerebro-spinal  axis. 

1.  Lesion  in  the  brain  proper,  the  optic  thalamus,  or  the  corpus  striatum. 

On  the  opposite  side.  On  the  same  side. 

Sensibility Diminished  or  lost  Normal 

Voluntary  movements Ditto,  ditto  Ditto 

Temperature       (even) Increased  Ditto 

without  fever)     .      ) 

2.  Lesion  of  the  pons  Varolii  or  the  medulla  oblongata  above  the  decussation  of 
the  anterior  pyramids. 

On  the  opposite  side.  On  the  same  side. 

Sensibility Diminished  or  lost     Increased 

Voluntary  movements Ditto,  ditto  Normal 

Temperature Diminished  Increased 

3.  Lesion  of  the  medulla  oblongata  at  the  level  of  the  decussation  of  the  ante- 
rior pyramids. 

On  the  opposite  side.  On  the  same  side. 

Sensibility Diminished  or  lost  Increased 

Voluntary  movements Ditto,  ditto  Diminished  or  lost 

Temperature Diminished  Increased 

4.  Lesion  of  the  spinal  cord. 

On  the  opposite  side.  On  the  same  side. 

Sensibility .Diminished  or  lost  Notably  increased 

Voluntary  movements      ....  vUfh^Ditto^  ditfro  Jioni'ly  noime>l fy/j^ 

Temperature Diminished  Increased 

It  is  unnecessary  to  say  that  nothing  is  more  variable  than  the 
degree  of  temperature  of  paralyzed  or  anaesthetic  parts,  and  that, 
therefore,  what  is  stated  in  the  above  table  ought  to  be  considered 
as  the  most  frequent  condition,  and  not  as  a  constant  one.  Paralyzed 
bloodvessels  may  contract  under  the  influence  of  cold,  and  the  tern- 


204  THE    CENTRAL    NERVOUS    SYSTEM. 

perature  and  the  hyperesthesia  of  a  part  may,  in  this  way,  diminish 
for  a  time.  On  the  other  hand,  contracted  bloodvessels  will  neces- 
sarily relax  after  a  long  period  of  contraction,  because  they  lose 
their  power  of  contraction  by  a  persistent  and  somewhat  spasmodic 
action,  and,  in  this  way,  anaesthetic  and  cold  parts  may  temporarily 
become  warm.1 


GENERAL  CONCLUSIONS  OF  THE  COURSE. 

Our  principal  object  in  these  lectures  has  been,  to  prove,  chiefly 
by  experiments  upon  animals  and  by  pathological  cases  observed 
in  man,  many  new  views  concerning  the  physiology  and  pathology 
of  the  central  nervous  system.  A  number  of  these  views  have 
been  proposed  by  myself;  whilst  the  others,  although  advanced  by 
several  physiologists,  have  not  yet  been  sufficiently  proved. 

At  the  same  time  that  we  have  tried  to  build  new  doctrines,  we 
have  shown  the  insufficiency  and,  sometimes,  the  complete  untena- 
bleness  of  certain  theories  which  had  been  more  or  less  generally 
admitted.  In  the  following  conclusions,  which  are  only  a  very 
small  part  of  those  that  might  be  drawn  from  the  facts  and  reason- 
ings which  have  been  mentioned  in  our  lectures,  we  will  point  out 
the  most  important  views  that  we  have  tried  to  establish: — 

1st.  Excitations  of  the  anterior  roots  of  the  spinal  nerves  may 
be  a  cause  of  pain,  because  these  roots,  being  motor,  produce  a 
cramp.  The  pain  due  to  this  cramp  is  what  has  been  erroneously 
called  recurring  sensibility.  Cramps,  and  several  other  kinds  of 
painful  spasms  (of  the  uterus  during  parturition,  of  the  sphincter 
ani  in  certain  cases,  &c),  are  painful  on  account  of  a  galvanic  irri- 
tation of  sensitive  nerves  accompanying  muscular  contractions. 
(Lecture  I.) 

2d.  Our  movements  seem  to  be  guided  by  the  peculiar  sensations 
we  derive  from  the  galvanic  irritation  of  certain  sensitive  nerves 
of  muscles,  while  they  contract.  (Lecture  I.) 

3d.  The  power  of  transmitting  sensitive  impressions  exists  in 
many  parts  which  are  not  able  to  give  pain  or  any  other  sensation 
when  they  are  excited  by  our  usual  means  of  irritation ;  so  it  is 
with  the  gray  matter  of  the  spinal  cord,  and  with  many  parts  of 

1  See  for  other  parts  concerning  this  subject  my  Experim.  Researches  applied  to 
Physiol,  and  Pathol.,  1853,  pp.  73-78. 


GENERAL    CONCLUSIONS.  205 

nerves,  which,  however,  are  conductors  of  sensitive  impressions. 
(Lecture  II.) 

4th.  Hyperesthesia  is  a  constant  result  of  certain  injuries  upon, 
or  alterations  of,  the  posterior  parts  of  the  cerebro-spinal  axis,  from 
the  tubercula  quadrigemina  down  to  the  lower  end  of  the  spinal 
cord.  (Lectures  II.,  IV,,  and  V.) 

5th.  The  transmission  of  sensitive  impressions,  in  the  spinal  cord, 
takes  place  chiefly  through  the  gray  matter,  and  partly  through  the 
anterior  columns;  but,  before  reaching  the  gray  matter,  the  impres- 
sions, in.  a  certain  measure,  pass  through  the  posterior  columns. 
(Lectures  II.,  IV.,  and  V.) 

6th.  The  conductors  of  sensitive  impressions  from  the  trunk  and 
limbs  decussate  in  the  spinal  cord,  and  not  in  the  encephalon,  as 
was  universally  admitted.  (Lectures  III.  and  VII.) 

7th.  Although  the  spinal  cord  is  greatly  altered  or  injured,  sen- 
sibility, more  or  less  diminished,  may  persist  everywhere,  on  account 
of  a  peculiar  arrangement  of  the  conductors  of  sensitive  impressions. 
(Lectures  IV.  and  VI.) 

8th.  The  various  kinds  of  sensitive  impressions  seem  to  be  trans- 
mitted by  quite  distinct  conductors,  in  the  nerves  and  in  the  nervous 
centres,  and  the  place  of  passage  of  some  of  these  conductors,  in 
the  spinal  cord,  seems  not  to  be  the  same  as  that  of  the  others,  but 
none  of  them  go  up  to  the  sensorium  along  the  posterior  columns. 
(Lecture  VII.) 

9th.  In  the  upper  part  of  the  cervical  region  of  the  spinal  cord, 
near  the  medulla  oblongata,  most  of  the  conductors  of  the  orders 
of  the  will  to  muscles  are  in  the  lateral  columns,  and  in  the  gray 
matter  between  these  and  the  anterior  columns.  (Lectures  IV.  and 
VIII.) 

10th.  The  voluntary  motor  conductors  decussate  at  the  lower 
part  of  the  oblong  medulla,  and  not  all  along  the  median  line  of 
the  base  of  the  encephalon.  (Lectures  VII.  and  XII.) 

11th.  The  posterior  columns  of  the  spinal  cord  have  a  great  share 
in  reflex  movements,  and  this  is  the  principal  cause  of  the  peculiar 
kind  of  paralysis  so  often  observed  in  cases  of  alteration  of  these 
columns.  (Lecture  VIII.) 

12th.  The  effects  of  excitation  of  the  vaso-motor  nerves  consist 
essentially  in  a  contraction  of  bloodvessels,  which  is  followed  by  a 
diminution  of  the  quantity  of  blood,  in  the  temperature,  and  in  the 
activity  of  nutrition.  The  effects  of  interruption  of  continuity  of 
the  vaso-motor  nerves  (■?'.  e.,  their  paralysis)  consist  essentially  in  a 


206  THE    CENTRAL    NERVOUS    SYSTEM. 

paralytic  dilatation  of  bloodvessels,  which  is  followed  by  a  greater 
afflux  of  blood,  an  increase  of  temperature,  and  a  greater  activity 
of  nutrition.  (Lecture  IX.) 

13th.  As  a  great  many  vaso-motor  nerve-fibres  go  up  to  the  brain 
and  to  the  cerebellum  along  the  spinal  cord,  the  medulla  oblongata 
and  the  pons  Varolii,  the  diseases  or  injuries  of  the  various  parts 
of  the  cerebro-spinal  axis,  besides  symptoms  concerning  sensibility 
and  movement,  present  symptoms  depending  upon  irritation  or 
paralysis  of  vaso-motor  nerves :  contraction  or  relaxation  of  blood- 
vessels, diminution  or  augmentation  in  the  quantity  of  blood, 
increase  or  diminution  of  temperature,  alterations  of  nutrition,  of 
secretions,  &c.  (Lectures  IX.  and  XII.) 

14th.  Besides  the  kind  of  influence  of  the  nervous  system  upon 
nutrition,  absorption,  and  secretion,  through  the  vaso-motor  nerves, 
there  is  another  kind,  which  seems  to  consist  in  changes  in  the  ele- 
ments of  the  tissues — changes  producing  various  modifications  in 
the  quantity  of  blood  attracted,  and  in  the  interchange  of  materials 
between  the  blood  and  the  tissues.  (Lectures  IX.  and  X.) 

15th.  The  absence  of  the  influence  of  the  nervous  system  on  any 
part  of  the  body  is  hardly  a  cause  of  other  alterations  of  nutrition 
than  atrophy,  while  the  irritation  of  the  nervous  system  is  a  most 
powerful  direct  or  reflex  cause  of  a  great  many  morbid  changes  in 
nutrition,  secretion,  &c.  (Lecture  X.) 

16th.  The  sympathetic,  normal,  and  morbid  changes  of  nutrition, 
secretion,  &c,  are  reflex  phenomena,  the  study  of  which  shows  how 
many  diseases  are  produced  by  a  reflex  action,  and  how  a  rational 
mode  of  treatment  might  be  arrived  at.  (Lectures  X.  and  XL) 

17th.  The  loss  of  consciousness  in  simple  vertigo  or  in  complete 
attacks  of  epilepsy  does  not  depend  upon  a  disease  of  the  brain, 
but  upon  a  contraction  of  the  bloodvessels  of  the  cerebral  lobes — 
contraction  due  to  some  irritation  of  the  vaso-motor  nerves  of  these 
vessels,  either  by  some  direct  cause  irritating  them  in  the  base  of 
the  encephalon  or  the  spinal  cord,  or  by  a  reflex  influence. 

18th.  Much  more  frequently  than  has  been  imagined,  all  the  fol- 
lowing affections  may  be  produced  by  a  peculiar  kind  of  irritation 
starting  from  almost  any  centripetal  part  of  the  nervous  system ; 
epilepsy,  the  various  forms  of  insanity,  chorea,  catalepsy,  hysteria, 
tetanus,  hydrophobia,  &c.  (Lectures  X.  and  XL) 

19th.  The  medulla  oblongata  is  neither  the  only  nor  an  essential 
nervous  centre  for  the  respiratory  movements.  (Lecture  XII.) 

20th.  There  are  a  great  many  nerve-fibres  and  nerve-cells  in  the 


GENERAL    CONCLUSIONS.  207 

medulla  oblongata,  the  pons  Yarolii,  and  the  other  parts  of  the  base 
of  the  encephalon,  which  are  not  employed  in  the  transmission  of 
sensitive  impressions  or  of  the  orders  of  the  will  to  muscles,  and 
are  endowed  with  the  singular  property  of  producing,  after  even  a 
slight  irritation,  a  persistent  spasm  in  certain  muscles,  and  especially 
in  the  neck.  Eotatory  convulsions  very  often  depend  chiefly  upon 
the  production  of  such  spasms,  and  of  changes  in  the  bloodvessels 
of  certain  parts  of  the  encephalon.  (Lecture  XII.) 

21st.  The  irritation  of  the  auditory  nerve  may  cause  rotatory  or 
simple  clonic  convulsions.  (Lecture  XII.) 

22d.  The  conductors  of  the  orders  of  the  will  to  muscles,  of  the 
sensitive  impressions  and  of  the  nervous  influences  to  bloodvessels, 
decussating  at  different  places  in  the  cerebro-spinal  axis,  various 
symptoms  are  to  be  observed,  depending  upon  either  the  irritation 
or  the  paralysis  of  these  three  kinds  of  conductors,  according  to  the 
part  of  a  lateral  half  of  the  cerebro-spinal  axis  where  an  alteration 
exists.  (Lecture  XII.) 


APPENDIX. 


APPENDIX. 


"We  propose  to  make  here  many  additions,  which,  we  hope,  will 
increase  the  value  our  lectures  may  have,  both  in  a  scientific  and 
in  a  practical  point  of  view.  There  are  objections  to  the  opinions 
we  have  advanced,  which  we  have  not  been  willing  to  discuss  in 
our  lectures,  for,  had  we  stopped  for  such  a  discussion,  this  inter- 
ruption might  have  proved  injurious  to  the  clearness  of  the  demon- 
strations. It  is  one  of  the  objects  of  this  appendix  to  examine  these 
objections.  On  the  other  hand,  there  are  deductions  for  the  treat- 
ment of  many  diseases,  which  are  to  be  drawn  from  the  principles 
that  we  have,  tried  to  establish  in  our  lectures;  it  is  also  one  of  the 
objects  of  this  appendix  to  give  the  most  important  of  these  deduc- 
tions. 


PART  I.  EXAMINATION  OF  OBJECTIONS  THAT  MIGHT  BE  MADE  AGAINST 
MANY  OF  THE  VIEWS  WHICH  ARE  HELD  IN  THE  PRECEDINC  LECTURES. 

"We  think  that  it  is  quite  wrong  to  say — as  many  physiologists 
and  practitioners  do — that  a  fact  is  not  true,  simply  because  it  is 
in  opposition  with  generally  admitted  views.  Many  discoveries 
might  be  made  by  scientific  inquirers,  who,  without  prejudice,  would 
collect  facts,  which,  though  they  seem  to  have  been  well  observed, 
appear  to  be  contrary  to  admitted  doctrines,  and  would  try  to  find 
out  an  explanation  of  these  facts.  We  will  only  say  that  there  is 
no  great  discovery  in  science  which  has  not  been  in  opposition 
with  previously  admitted  doctrines.  The  preceding  assertion  will 
serve  as  an  apology  for  the  discussion  of  certain  facts,  the  exist- 
ence or  the  exactitude  of  which  has  been  generally  doubted,  al- 
though it  seems  to  have  been  positive. 


212  APPENDIX. 


1.  Alleged  existence  of  voluntary  movements  and  of  sensibility  in 
children  apparently  deprived  of  the  cerebrospinal  axis. 

I  think  that  it  is  now  impossible  to  deny  that  there  have  been 
cases  in  which  such  monsters  (Amyelejicephalous,  Be"clard),  have  had 
movements,  either  inside  or  outside  of  the  uterus,  and,  without 
doubt,  purely  reflex,  and  which  have  been  mistaken  for  voluntary 
movements,  and  admitted  as  a  proof  that  sensibility  existed.  Among 
numerous  cases  collected  by  Isidore  Geofifroy  St.  Hilaire1  and  by 
Ollivier  d' Angers,2  there  are  some  which  cannot  be  considered  as 
entirely  erroneous  statements,  and,  to  laugh  at  the  believers  in 
these  facts,  as  Longet3  does,  cannot  be  an  argument  against  their 
existence.  What  is  to  be  done  is,  no  more  to  deny,  but  to  try  to 
explain,  and  this  I  will  do,  after  having  related  some  extremely 
curious  cases,  recently  published,  and,  perhaps,  better  authenticated 
than  those  of  which  Longet  has  spoken. 

The  first  case  I  will  relate  is  recorded  in  the  very  rich  and  in- 
teresting catalogue  of  the  Boston  Anatomical  Museum,  for  which 
science  is  indebted  to  the  zeal  and  activity  of  my  learned  friend 
Prof.  J.  B.  S.  Jackson. 

Case  1. — A  pregnant  woman  did  not  feel  the  movements  of  her 
child,  until  about  the  end  of  the  fifth  month,  and  they  were  always 
feeble  and  peculiar.  In  the  last  month,  slight  motions  of  the  child 
were  still  occasionally  felt,  even  after  a  profuse  discharge  of  liquor 
amnii.  Labor  came  on,  and  was  accomplished  with  very  little  pain; 
the  child  was  born  alive,  the  mother  having  felt  its  motions  for  fif- 
teen or  twenty  minutes  after  it  was  expelled.  On  the  arrival  of  Dr. 
Hildreth,  half  an  hour  afterwards,  the  lower  extremities  of  the  child 
were  still  in  the  vagina. 

Autopsy. — The  spinal  marrow  was  wanting,  and  the  spinal  column 
being  open  throughout,  the  nerves  terminated  in  the  membrane 
upon  its  posterior  face.  A  very  small  bundle  of  nervous  fibres 
was  seen  passing  down  over  five  or  six  of  the  processes  upon  the 
left  side,  and  a  few  of  the  cranial  nerves  were  found,  among  which, 
it  was  thought,  was  the  par  vagum.  Nerves  of  the  trunk  and 
extremities  well  developed. 

1  Hist,  des  Anomalies  de  l'Organisation,  vol.  ii.  1836,  pp.  344-351,  and  371-4. 

2  Loco  cit.,  vol.  i.  p.  146. 

3  Anat.  et  Physiol,  du  Syst.  Nerv.,  1842,  vol.  i.  p.  323. 


EXAMINATION    OF    OBJECTIONS.  213 

The  brain  existed,  weighing  three  ounces  (the  weight  of  the 
monster  being  three  pounds  and  one  ounce).  It  rested' upon  the 
expanded  dorsal  and  lumbar  vertebras,  and  upon  the  integument 
which  covered  the  depressed  cranial  bones.  It  was  divided  into 
two  equal  hemispheres,  and,  imperfectly,  into  convolutions,  the 
arachnoid  membrane  being  continuous  about  the  base  with  the 
common  integument.  The  whole  mass  was  very  soft,  and  of  a 
dusky  color,  from  congestion,  and  effused  blood ;  there  being  in  each 
hemisphere  a  cavity  which  was  rilled  with  coagula.  No  other  parts 
of  the  brain  were  recognized,  and  no  connection  was  traced  be- 
tween this  mass  and  any  of  the  nerves,  either  cerebral  or  spinal.1 

It  is  to  be  regretted  that  some  circumstances  have  not  been 
pointed  out  in  this  case,  and,  for  instance,  the  size  of  the  ganglions 
of  the  sympathetic  and  of  the  spinal  nerves. 

The  movements  of  the  child,  after  birth,  not  having  been  ascer- 
tained by  the  physician  himself,  we  cannot  know  whether  they 
were  respiratory,  convulsive,  or  reflex.  As  to  what  took  place 
before  birth,  if  we  can  rely  upon  the  assertion  of  the  mother,  there 
have  been  movements,  but  they  began  late,  although  much  sooner 
than  these  uterine  contractions,  which  are  sometimes  mistaken  for 
movements  of  the  child.  The  mother  had  had  already  two  chil- 
dren, and  therefore  was  able  to  distinguish  the  movements  of  a 
child. 

I  must  say  also  that,  in  a  physiological  point  of  view,  although 
the  brain  was  existing  in  this  monster,  it  is  exactly  as  if  it  had  been 
missing,  because  it  was  not  connected  with  the  nerves. 

In  the  following  case  we  will  find  that  movements  have  existed, 
during  pregnancy,  in  a  case,  the  circumstances  of  which  may  lead 
us  to  explain  how  movements  can  exist. 

Case  2. — A  woman,  pregnant  for  the  sixth  time,  was  not  aware 
of  the  fact,  although  her  abdomen  had  become  large,  and  her  men- 
struation had  stopped,  and  she  was  much  surprised  when  she  felt 
the  movements  of  her  child,  which  were  so  strong,  that  even  the 
hand  of  another  person  could  perceive  them.  The  8th  of  May,  she 
felt  the  movements  for  the  last  time ;  and  after  the  expulsion  of  a 
very  considerable  quantity  of  water,  she  was  delivered  of  a  child, 

1  A  Descriptive  Catalogue  of  the  Anatomical  Museum  of  the  Boston  Society  for 
Medical  Improvement.  By  J.  B.  S.  Jackson,  1847,  p.  263.  (Case  by  Dr.  Charles  T. 
Hildreth.) 


214  APPENDIX. 

who,  out  of  the  uterus,  remained  motionless.  Its  weight  was  from  3 
to  3J  lbs.  It  had  no  neck,  and  the  head — very  small — appeared  to 
be  lodged  in  a  cavity  in  the  trunk.  From  the  upper  part  of  the 
orbitary  arcade,  the  skin  was  missing  all  over  the  head.  The  spinal 
canal,  open  all  along,  from  the  cranium  to  the  lumbar  region,  con- 
tained a  spinal  cord,  being  in  shape  like  a  band,  flattened  from  be- 
hind forwards,  and  of  about  one  line  and  a  half  in  thickness;  its 
beginning  at  the  base  of  the  cranium  was  somewhat  bifurcated,  and 
evenly  cut.  It  was  lying  on  a  fatty  and  fibrous  mass,  which  filled 
a  deep  excavation,  found  in  the  place  where  the  neck  should  have 
been,  had  it  existed.  This  medullary  band  was  very  loosely  at- 
tached to  the  spinal  canal,  by  some  fibrous  filaments.  This  band 
had  no  connection  with  the  nerves,  which  terminated  in  the  verte- 
bral foramina  by  a  swollen  and  ganglionary  extremity.  In  the 
trunk  and  limbs,  the  nerves  were  well  developed.  There  was  no 
brain.  The  chest  was  large;  no  respiration  had  taken  place,  as  the 
lungs  showed.  The  upper  part  of  the  cranium  was  missing,  and 
the  basis  was  convex. 

It  is  very  much  to  be  regretted  that  Dr.  Olier,1  to  whom  wre  owe 
the  relation  of  this  interesting  case,  has  not  given  more  details 
about  the  nervous  system.  He  does  not  speak  either  of  the  cranial 
nerves  or  of  the  sympathetic. 

I  have  now  to  examine  the  value  of  the  two  cases  I  have  related, 
and  of  many  other  analogous  to  them,  which  are  more  or  less 
authenticated. 

The  first  question  is,  whether  there  has  been  any  decided  volun- 
tary movement,  and  any  perception  of  a  sensitive  impression  in 
these  monsters. 

Nothing  proves  that  sensibility  exists,  and  the  movements  con- 
secutive to  an  excitation,  however  regular  or  co-ordinate  they  may 
be,  cannot  give  such  a  proof.  Nothing  in  these  circumstances 
proves  that  these  movements  are  not  reflex.  It  is  now  generally 
admitted,  as  Bischoff,2  Prof.  Simpson,3  and  others  have  established, 
that  the  movements  of  healthy  children  in  the  uterus,  and  even  for 
some  time  after  birth,  are  merely  reflex.  If  it  is  so  for  them,  a 
fortiori,  is  it  so  for  the  pseudencephalic  monsters.  These  reasons 
against  the  existence  of  sensibility  may  be  employed  against  that 

1  Observ.  d'un  foetus  Anencephale,  in  Comptes  Rendus  de  la  Soc.  de  Biologie, 
1S50,  vol.  ii.  p.  106. 

2  Traite  du  developpement  de  l'liomme. — Trad"10,  franchise,  1843,  p.  459. 

3  Edinb.  Monthly  Journal  of  Med.  Science,  July,  1849. 


EXAMINATION    OF    OBJECTIONS.  215 

of  a  Will,  in  these  monsters.  Their  movements  are  almost  always 
consecutive  to  an  external  excitation.  Nevertheless  we  admit  that 
they  have,  sometimes,  an  apparently  spontaneous  movement ;  but, 
we  well  know  that  reflex  movements  may  be  excited  by  any  irrita- 
tion of  the  viscera,  and  that  the  respiratory  movements  of  the  chest 
may  excite  reflex  movements  in  the  limbs.  Besides,  the  same  ex- 
citation which  produces  respiratory  movements,  is  able  to  produce 
movements  in  the  limbs.  I  have  tried  to  prove,  in  a  work1  which 
I  published  five  years  ago,  that  the  nerves,  muscles,  and  some  other 
parts  of  the  body,  may  be  excited  to  act,  by  blood,  containing  a 
great  quantity  of  carbonic  acid.  Very  likely,  respiratory  move- 
ments, in  monsters,  as  well  as  in  healthy  children  and  adults,  take 
place  in  consequence  of  an  excitation  produced  by  carbonic  acid, 
and  an  excitation,  by  this  agent,  may  also  be  the  cause  of  some  of 
the  falsely  called  voluntary  movements  in  the  pseudencephalic  mon- 
sters.2 

To  conclude,  we  will  say  that,  if  there  appears  to  be  no  doubt 
that  movements  may  exist  in  these  monsters,  nothing  proves  that 
they  are  voluntary  and  that  they  result  from  true  sensations.  On 
the  contrary  they  appear  to  be  purely  reflex  or  mere  excited  move- 
ments. 

A  second  question  now  arises,  much  more  difficult  to  be  solved 
than  the  preceding.  How  to  explain  reflex  movements,  if  there  is 
no  spinal  cord,  or  if  this  organ,  though  existing,  is  not  united  with 
the  nerves? 

Let  us  examine  alternately  the  different  possible  explanations. 

1st.  A  man  of  genius,  Etienne  GeofYroy  St.  Hilaire,3  has  given 
credit  to  the  idea  that  the  liquid  which  is  sometimes  found  in  the 
pseudencephalic  monsters,  in  the  cranio-spinal  cavity,  and  filling 
there  a  tube,  formed  by  the  meninges — may  be  considered  as  con- 
taining the  elements  of  the  brain  and  spinal  cord,  in  their  primitive 
state  of  development.  In  many  cases  this  liquid  is  not  found  in 
the  membranous  tube  formed  by  the  meninges,  but  then  it  appears 

1  Experimental  Researches  applied  to  Physiol,  and  Pathol.  New  York,  1853,  pp. 
101-113. 

*  The  pseudencephalic  monsters  compose  the  genus  Pseudenctfphale  of  the  family 
of  the  Pseudenc<?phaliens  of  E.  Gr.  St.  Hilaire.  They  correspond  to  the  Amyehnc4- 
phales  of  Beclard.  The  characters  of  the  genus  are  to  have  the  spinal  canal  open 
and  no  spinal  cord,  and,  besides  (as  family  characters),  no  true  encephalon,  and, 
in  its  place,  a  vascular  tumor,  which  may  contain  some  nervous  matter. 

3  Philosophic  anatomique. — Des  Monstruosites  humaines,  1822,  vol.  i.  pp.  125-153. 


216  APPENDIX. 

to  have  gone  out,  together  with  the  liquor  amnii,  before  parturi- 
tion. 

This  theory  is  quite  opposed  to  the  well  known  doctrine  of  Mor- 
gagni,1  who  admitted  that  the  production  of  the  liquid,  found  in,  or 
coming  from  the  cranio-vertebral  cavity,  is  the  result  of  a  morbid 
action,  and  that  a  true  dropsy  is  the  cause  of  the  destruction  of  the 
nervous  centres. 

Of  these  two  opinions,  if  we  adopt  the  first,  as  regards  the  source 
and  the  nature  of  the  liquid,  we  cannot,  nevertheless,  adopt  entirely 
the  view  of  E.  G.  St.  Hilaire,  that  this  liquid  may  act  as  the  brain 
and  spinal  cord  would.  We  know  that  as  long  as  the  nervous 
centres  are  in  a  liquid  state,  in  the  human  embryo,  there  are  no 
movements,  and  I  have  ascertained  that  this  does  not  result  from 
an  insufficiency  in  the  development  of  muscles.  In  embryos  of 
rabbits,  from  eight  to  twelve  days  old,  I  have  found  the  muscles 
irritable  and  producing  movements  when  directly  excited,  and  their 
nervous  centres,  then  almost  entirely  liquid,  appeared  not  to  be 
endowed  with  any  power  of  action.  But  it  may  be  that  the  liquid 
we  find  in  the  vertebral  canal  of  monsters,  contains  a  sufficient 
number  of  soft  nerve-fibres  and  cells,  to  produce  some  reflex  move- 
ments. Micrograpbers,  and  they  alone,  may  solve  the  question  of 
the  existence  of  these  nervous  elements  in  this  liquid. 

If  we  admit  as  true  the  doctrine  of  Morgagni,  it  belongs  still 
more  to  micrographers  to  point  out  what  nervous  elements  are  left 
in  the  cases  where  the  naked  eye  shows  only  a  liquid. 

2d.  A  second  explanation  might  prove  good  for  a  number  of 
cases,  and  especially  those  like  the  one  of  Dr.  Olier,  which  I  have 
related.  A  rudiment  of  the  spinal  cord  exists,  but  is  not  found 
united  with  the  nerves.  For  those  who  know  how  easily  in  foetuses, 
healthy  or  not,  the  roots  of  the  spinal  nerves  may  become  separated 
from  the  spinal  cord  and  also  from  the  ganglions,  and,  besides,  may 
break  in  any  part  of  their  length,  particularly  when  there  is  an 
unusual  amount  of  water  around  them — it  will  be  easy  to  under- 
stand that,  in  monsters,  the  roots  of  the  nerves  may  not  have  been 
found,  although  they  may  have  existed.  It  is  known  that  a  very 
able  anatomist,  Desmoulins,  having  vainly  searched  for  the  roots 
of  the  spinal  nerves  in  fishes,  concluded  that  they  do  not  exist,  and 
that  the  nerves,  in  these  animals,  are  attached  to  the  meninges. 
Desmoulins  has  been  greatly  mistaken,  and  if  he  has  been  so,  in 

•  De  sedibus  et  causis  Morboruni.  Epist.  12. 


EXAMINATION    OF    OBJECTIONS.  217 

such  circumstances,  it  will  easily  be  admitted  that  others,  not  so 
accustomed  as  he  was  to  dissections,  may  commit  the  same  error, 
in  circumstances  more  favorable  to  a  mistake. 

In  experiments,  that  I  have  performed  on  birds  and  other  ani- 
mals, I  have  found  that  reflex  actions  may  exist  after  considerable 
alterations  of  the  spinal  cord.  I  will  hereafter  give  the  details  of 
some  of  these  facts  and  of  some  others  proving  that,  not  only  then, 
reflex  actions  may  exist,  but  also  sensations  and  voluntary  move- 
ments. We  can,  therefore,  understand  that  a  small  stripe  of  the 
spinal  cord,  as  in  the  case  of  Dr.  Olier,  if  it  is  connected  with  the 
nerves,  may  be  the  cause  of  the  reflex  movements  existing  in  the 
pseudencephalic  monsters. 

3d.  We  are  led  to  propose  a  third  explanation,  based  upon  some 
anatomical  facts,  observed  in  amyelencephalians,  and  also  upon  the 
experiments  we  have  just  spoken  of,  and  which  prove  that  small 
parts  or  stripes  of  the  spinal  cord  may  be  sufficient  for  reflex 
actions. 

In  some  cases  of  anencephalia  or  of  pseudencephalia,  the  roots  of 
the  nerves  have  been  found  hanging,  apparently,  as  loose  threads 
in  the  cranial  and  spinal  cavity.  In  cases  of  this  kind,  reported  by 
Dr.  Lonsdale1  and  Prof.  Paget,2  it  has  been  found  that  the  nerve- 
fibres  formed  loops,  imbedded  in  a  filamentous  tissue  and  sur- 
rounded by  numerous  granules.  It  is  probable,  and  it  is  consi- 
dered to  be  so  by  Prof.  Paget,  that  this  granular  matter  may  be 
regarded  as  gray  matter,  in  an  early  stage  of  development. 

I  am  not  prepared  to  say  that  these  loops  and  this  slightly  de- 
veloped gray  matter  are  capable  of  producing  reflex  movements, 
strong  enough  to  be  observed,  but  I  think  that  they  may  help  other 
parts  in  the  production  of  these  movements. 

An  amount  of  gray  matter,  much  greater  than  that  found  by 
Drs.  Lonsdale  and  Paget,  may  certainly  have  existed,  in  cases  of 
amyelencephalia,  and  no  notice  taken  of  it,  by  physicians  who  were 
not  prepared  to  consider  it  as  nervous  matter.  And  this  amount 
of  gray  matter,  connected  with  the  roots  of  the  nerves,  may  have 
been  able  to  produce  reflex  movements.3 

1  Edinb.  Med.  and  Surg.  Journal,  January,  '44. 

2  Brit,  and  For.  Med.  Rev.,  No.  48,  p.  273. 

3  It  is  very  much  to  be  regretted  that  the  recorders  of  the  cases  numbered  776, 
778,  781,  in  the  Catalogue  of  the  Boston  Museum,  have  not  said  if  the  mothers  of 
the  monsters  they  describe,  had  felt  them  move,  during  the  last  days  of  pregnancy. 
As  regards  the  case  No.  776,  p.  254,  the  writer  says  :  "  A  trace  of  brain  only  existed 


218  APPENDIX. 

The  possibility  of  existence  of  reflex  movements  when  the  spinal 
cord  is  reduced  to  only  a  part  of  its  substance,  is  well  proved  by 
the  following  experiments.  Two  pigeons  had  had  their  spinal  cord 
divided  transversely,  at  about  the  middle  of  its  length.  A  metallic 
wire  was  passed  in  the  spinal  canal  and  pushed,  from  the  place 
where  the  cord  had  been  cut,  until  the  level  of  the  second  or  third 
caudal  vertebra.  In  one  of  these  animals  there  has  been,  a  short 
time  after  the  operation,  weak  but  positive  reflex  movements,  in  the 
tail  and  the  posterior  limbs,  whatever  was  the  excited  point.  For 
many  days  and  until  the  time  when  this  animal  was  killed,  reflex 
action  lasted.  The  dissection  of  the  animal  was  made  at  a  meeting 
of  the  Society  of  Biology,1  and  all  the  posterior  surface  of  the  cord 
was  found  covered  with  coagulated  blood ;  the  cord  was  flattened 
from  behind  forwards,  softened  in  all  its  thickness,  and  it  had  in 
many  places  a  violet,  reddish  color,  without  doubt  due  to  infiltra- 
tions of  blood.  This  half  liquid  gray  matter  which,  in  birds,  exists 
in  the  rhomboidal  ventricle,  was  destroyed,2  and  the  posterior  co- 
lumns of  the  cord  were,  almost  everywhere,  separated  one  from  the 
other,  so  that  the  central  gray  matter  was  laid  bare. 

In  the  other  pigeon  there  wrere  evident,  but  weak,  reflex  move- 
ments, only  in  the  left  posterior  limb  and  in  the  tail ;  excitations 
of  the  skin  of  the  right  posterior  limb  were  absolutely  without 
effect.  Dissection  being  made,  in  presence  of  the  Society  of  Biology, 
it  was  found  that,  in  a  great  length,  the  right  side  of  the  spinal 
cord  had  been  entirely  destroyed,  and  that  the  other  half,  which 
existed,  was  red  and  softened,  and  in  communication  with  the  roots 
of  the  nerves  and  with  the  caudal  part  of  the  cord,  which  was  but 
little  altered. 

I  have  performed  other  experiments  of  the  same  kind,  on  some 
mammals,  and  succeeded  in  obtaining  like  results,  particularly  on 
very  young  ones.  Newly-born  cats  are  the  best  animals  for  such 
experiments.     Before  my  researches,  experiments  of  this  kind  had 

if  any  at  all,  but  in  the  situation  of  the  pituitary  gland,  there  was  found  a  soft, 
rounded,  reddish  mass  ;  and  there  was  some  appearance,  also,  of  a  thin  and  super- 
ficial layer  of  medullary  substance  in  place  of  the  spinal  marrow ;  and  the  same 
has  been  sometimes  observed  in  other  similar  cases ;  spinal  nerves  and  ganglia 
well  developed,  as  they  usually  are  in  these  cases." 

1  See  Comptes  Rendus,  vol.  ii.  1850,  p.  47. 

2  I  have  already  published,  eight  years  ago,  a  very  curious  fact  about  this  gray 
matter :  it  is  that  when  it  is  taken  away,  a  reproduction  of  a  similar  substance 
takes  sometimes  place  in  a  very  short  time. 


EXAMINATION"    OF    OBJECTIONS.  219 

been  made,  but  only  on  frogs  and  other  cold-blooded  animals,  by 
Yolkmann,  Van  Deen  and  Stilling. 

The  resemblance  between  what  takes  place  in  the  animals  I  have 
experimented  upon,  and  what  exists  in  monsters,  extends  farther 
than  the  co-existence  in  both,  of  reflex  movements  and  of  a  small 
amount  of  nervous  matter,  in  the  spinal  canal.  I  have  found1  that, 
in  animals,  having  had  a  part  of  their  spinal  cord  crushed,  there 
were,  besides  reflex  movements,  convulsions,  and,  in  certain  mus- 
cles, contractures  producing  deviations  of  different  parts  of  the 
limbs.  So  that  I  had  there,  under  my  eyes,  the  phenomena  which 
exist  in  the  production  of  deviations,  in  the  limbs  of  monsters, 
according  to  the  theory  of  Dr.  Jules  Guerin. 

4th.  The  last  explanation  I  will  propose,  is  founded  on  the  fact 
that  the  ganglia  of  the  spinal  nerves  and  those  of  the  sympathetic 
are  generally  much  developed,  in  monsters  deprived  of  a  great 
part  or  of  the  whole  of  their  cerebro-spinal  axis,  as  Breschet,  Lal- 
lemand2  and  others  have  pointed  out. 

In  the  case  of  Dr.  Olier,  above  reported,  we  see  that  the  spinal 
nerves  had,  in  the  vertebral  foramina,  a  swollen  and  ganglionary 
extremity.  In  a  very  interesting  case  of  acephalia,  recorded  by 
Prof.  0.  W.  Holmes,3  although  the  spinal  marrow  existed,  the  gan- 
glia of  the  sympathetic  nerve,  and  the  filaments  connecting  them, 
were  unusually  developed  in  the  thorax,  abdomen  and  pelvis  ;  in 
the  thorax  were  two  ganglia,  which  extended  from  the  upper  rib 
to  about  the  eighth  rib  upon  the  right  side  and  to  the  sixth  on  the 
left.4    In  this  case  the  two  upper  limbs  and  the  head  were  missing. 

The  increase  in  size  of  the  ganglia  in  these  monsters  may  easily 
be  explained.  The  blood,  containing  the  chemical  elements,  which 
are  to  be  used  in  the  formation  of  the  nervous  tissues,  their  depo- 
sition ought  to  take  place,  in  the  only  parts  of  the  nervous  system 
which  exist,  and,  the  less  there  are  of  such  parts,  the  greater,  as  a 
general  rule,  ought  to  be  the  accumulation  of  nervous  matter  in 
them. 

It  is  to  be  regretted  that  in  cases  where  the  spinal  cord  was 

1  See  Comptes  Rendus  de  la  Soc.  de  Biologie,  vol.  iii.  1851,  p.  15. 

2  Observ.  patliol.  propres  a  eclairer  plusieurs  points  de  Physiol.,  1818,  p.  30. 

3  Catalogue  Boston  Museum,  p.  245. 

4  It  is  interesting  to  compare  this  description  with  the  statement  of  Antoine  and 
Malacoune,  who  say  that  in  acephalian  lambs  all  the  nerves  originated  from  a 
ganglion  in  the  abdomen.  (See  the  already  quoted  work  of  I.  Geoffroy  St.  Hilaire, 
vol.  ii.  p.  516.) 


220  APPENDIX. 

missing,  and  the  ganglia  of  the  sympathetic  nerve  were  enlarged, 
it  has  not  been  examined  if  the  branches  of  communication  between 
the  motor  and  sensitive  spinal  nerves  were  not  larger  than  usual. 
The  importance  of  such  an  examination  becomes  evident  if  we 
suppose  a  case  of  amyelencephalia,  in  which  it  would  be  positive: 
1st,  that  there  has  been  recently  more  or  less  reflex  movements; 
2d,  that  there  is  no  trace  whatever  of  the  encephalon  and  of  the 
spinal  cord. 

Then,  we  have  either  to  give  up  all  the  teachings  of  daily  experi- 
mentation and  observation,  about  the  necessity  of  nervous  centres 
for  the  production  of  movements,  after  an  excitation  of  the  skin  or 
of  another  surface — or  to  look  upon  the  ganglia  of  the  spinal 
nerves  or  of  the  sympathetic,  or  of  both,  as  the  nervous  centres 
which,  by  their  reaction,  originate  these  movements.  At  first,  we 
already  know  that  these  ganglia  are  larger  than  usual;  but  to  admit 
the  hypothesis  to  which  we  are  forcibly  led,  some  other  things  must 
exist.  If  the  ganglia  of  the  sympathetic  alone  are  enlarged  and 
are  endowed  with  reflex  power  over  the  muscles  of  the  limbs  and 
trunk,  of  course,  the  nerves  of  these  parts  must  be  connected  by 
many  more  nerve-tubes  than  usual,  with  these  ganglia.  In  other 
words,  the  origin  of  the  excito  and  reflecto-motor  nerve-fibres  of  the 
limbs  and  trunk  must  be  in  these  ganglia,  instead  of  being,  as  nor- 
mally, in  the  spinal  cord.  This  implies,  not  only  that  the  branches 
of  communication,  between  the  spinal  nerves  and  the  ganglia  of  the 
sympathetic,  must  be  larger  than  usual,  but,  also,  that  the  fibres 
come  from  the  periphery  of  the  spinal  nerves  into  the  branches  of 
communication.  If,  instead  of  being  in  the  ganglia  of  the  sympa- 
thetic, the  enlargement  is  in  those  of  the  spinal  nerves,  then  the 
fibres  of  the  motor  roots,  instead  of  merely  passing  along  the  gan- 
glia, will  penetrate  them,  and  be  connected  there  with  the  cells  of 
the  gray  matter  and  with  the  excito-motor  fibres,  as,  normally,  in 
the  spinal  cord. 

The  four  explanations,  or  rather  the  four  hypotheses,  wdiich  I 
have  exposed,  and  by  which  I  believe  that  we  may  understand  how 
are  produced  the  reflex  movements  in  monsters,  apparently  deprived 
of  the  cerebro-spinal  axis,  may  be  solved  by  future  examination. 
My  object  in  relating  these  hypotheses  was  double;  it  was,  1st,  to 
show,  that  there  is  possibility  of  explaining  the  movements  of  these 
monsters,  so  that  we  are  not  compelled  to  admit  that  our  general 
ideas  about  the  physiology  of  the  nervous  system  are  not  grounded; 


EXAMINATION    OF    OBJECTIONS.  221 

2d,  to  call  the  attention  of  future  observers  to  what  they  will  have 
to  examine  in  amyelence.phalous  monsters,  and  to  the  causes  of  fal- 
lacies, in  making  such  an  examination.  And,  in  view  of  this  second 
object,  I  will  sum  up,  here,  what  I  think  ought  to  be  searched  in 
such  cases. 

1st.  The  composition,  chemical  and  microscopical,  of  the  liquid, 
contained  in  or  coming  from  the  tube  formed  by  the  meninges,  to 
ascertain  the  degree  of  analogy  between  this  liquid  and  the  nerv- 
ous tissues,  at  an  early  period  of  development. 

2d.  The  existence  or  absence  of  small  masses  of  granular  matter, 
connected  one  with  another,  and  connected,  also,  with  the  spinal 
and  cranial  nerves.  Of  course,  the  nature  of  the  granular  matter 
must  also  be  determined. 

3d.  The  existence  of  communications  between  the  nerves,  and 
a  more  or  less  developed  stripe  of  spinal  cord;  and,  about  this,  it 
must  be  remembered  that  the  nerves  are  so  soft,  so  fragile,  that 
they  may  be  very  easily  separated  from  the  spinal  cord,  as  it  may 
have  been,  in  one  of  the  two  monsters,  the  case  of  which  is  above 
described. 

,  4th.  The  enlargements  of  the  ganglia  of  the  spinal  nerves  and 
of  those  of  the  sympathetic  and  all  what  relates  to  the  communi- 
cation of  these  ganglia  with  the  nerve-fibres  corning  from  or  going 
to  the  trunk  and  limbs,  must  be  examined  carefully. 

There  are  some  important  facts  relative  to  the  pseudencephalic 
monsters,  of  which  I  must  say  here  a  few  words. 

As  far  as  examination  with  the  naked  eye  goes,  it  seems  that  the 
development  of  muscles  and  nerves  in  these  monsters,  born  at  full 
term,  is,  almost  always,  as  perfect  as  in  the  most  healthy  newly- 
born  children.1  The  fact  that  muscles  are  well  developed,  proves 
that  they  have  been  put  in  action,  and  as  they  can,  hardly,  have 
been  acting,  without  having  been  excited  by  nerves,  it  follows  that 
the  nerves  must  have  been  able  to  act,  at  least,  until  a  short  time 

1  The  theory  of  Tiedemann  (Zeitschrift  fuer  Physiol.,  vol.  i.  p.  56,  vol.  iii.  p. 
1),  that  the  nervous  system  is  necessary  to  the  development  of  the  embryo  is  cer- 
tainly not  more  exact  than  the  analogous  theory,  according  to  which  the  nervous 
system  is  necessary  to  secretion  and  nutrition,  in  children  and  adults.  As  I  have 
tried  to  show  elsewhere  (Exp.  Researches  applied  to  Physiol,  and  Pathol.,  New 
York,  1853,  pp.  6-17),  the  numerous  facts,  which  establish  that  the  nervous  system 
may  have  a  great  influence  on  nutrition  and  secretions,  do  not  prove  that  this 
influence  is  necessary,  and  there  are  many  other  facts  proving,  on  the  contrary, 
that  the  functions  may  exist,  without  any  intervention  of  the  nervous  system. 
Against  the  views  of  Tiedemann,  see  Bischnffy  loco  cit.,  p.  468. 


222  APPENDIX. 

before  the  monster  is  expelled  from  the  uterus.  And  as  the  nerves 
do  not  act  spontaneously,  but  after  an  excitation,  and,  besides,  as 
there  is  no  known  sufficient  cause  of  direct  excitation  of  the  re- 
ilecto-motor  nerves,  it  results  that  the  action  of  these  nerves  is  a 
secondary  one,  produced  by  a  reflex  action  from  a  nervous  centre, 
itself  excited,  in  consequence  of  an  irritation  of  some  excito-motor 
nerves,  in  the  skin  or  in  the  mucous  membranes. 

This  series  of  deductions  being  right,  it  may  fairly  be  concluded 
that  even  in  cases  where  it  is  not  known  if  a  mother  has  felt  the 
movements  of  her  child,  monstrous  or  not,  it  is  probable  that  it 
has  bad  reflex  movements,  if  its  muscles  are  well  developed.  In 
cases  of  monsters,  in  which  the  nerves  have  not  been  able  to  act 
on  the  muscles,  either  because  there  are  no  nervous  centres  at  all, 
able  to  put  them  in  action,  by  their  reflex  power,  or  because  the 
nerves  have  not  had  their  natural  development,  the  muscles  do  not 
develop  themselves,  or  if  they  have  had  a  beginning  of  develop- 
ment, they  become  atrophied  and  changed  into  fibrous  or  fatty 
tissue,  according  to  circumstances,  which  an  eminent  physician,  Dr. 
Jules  Gue'rin,  has  pointed  out. 

Alessandrini1  has  described  two  monsters,  in  which  the  inferior 
part  of  the  spinal  cord  and  its  nerves  were  insufficiently  developed, 
and  the  muscles  of  the  posterior  limbs  were  missing,  although  the 
bloodvessels,  bones,  and  other  parts,  partly  existed.  In  cases  of 
absence,  not  only  of  the  nervous  centres,  but  also  of  the  nerves, 
such  as  have  been  recorded  by  Clarke2  and  by  Ilempel,3  the  muscles 
had  hardly  any  existence. 

As  a  conclusion  to  all  that  we  have  exposed  about  the  amyelen- 
cephalous  or  pseudencephalic  monsters,  we  will  say  that  their 
movements  appear  to  be  merely  reflex,  and  that,  although  they  are 
deprived  of  the  greatest  part  of  their  nervous  centres,  there  is, 
according  to  the  greatest  probability,  enough  of  these  parts  remain- 
ing to  produce  reflex  actions.4 

Therefore,  it  cannot  be  concluded,  from  the  facts  observed  in 

1  Novi  Comment  Scienc.  Instit.  Boncm,  vol.  iii.,  1837. 

2  Philos.  Trans.,  1793. 

3  De  monstris  Acephalis,  Hafnice,  1850,  p.  38,  and  Tabuloo  5  and  G. 

4  Another  kind  of  movements  ruay  exist  in  monsters  entirely  independent  from 
the  nervous  centres,  and  produced,  as  we  have  already  said,  by  some  local  cause 
of  excitation,  just  as  those  singular  movements  in  the  body  of  man  after  death 
by  yellow  fever  or  cholera,  and  described  particularly  by  Dr.  Bennet  Dowler,  of  New 
Orleans,  and  by  my  pupil,  Dr.  Brandt,  after  his  own  observations  and  mine. 


EXAMINATION    OF    OBJECTIONS.  223 

monsters,  that  the  encephalon  is  not  necessary  for  the  perception 
of  sensitive  impressions  and  for  the  production  of  voluntary  move- 
ments. 

2.  Alleged  existence  of  voluntary  movements  and  sensibility,  in  parts  of 
the  body,  considered  as  deprived  of  their  natural  connection  with  the 
encephalon. 

As  I  have  already  answered  partly  to  objections  of  this  kind  in 
Lectures  V.  and  VI.,  I  will  merely  say  here :  1st.  That  the  cases 
of  softening  of  the  spinal  cord,  related  by  Velpeau,1  Ollivier 
d'Angers  and  Abercrombie,  in  which  no  paralysis  has  existed, 
although  there  appeared  to  be  an  interruption  of  continuity,  be- 
tween the  nerve-fibres  of  some  parts  of  the  body  and  the  encephalon, 
are  not  fit  to  prove  that  this  continuity  is  not  necessary.  Until  it 
is  demonstrated  that  the  nerve-fibres  and  the  cells  of  the  cord  lose 
completely  their  properties  when  they  are  softened,  these  facts  will 
prove  nothing  against  the  necessity  of  the  continuity  of  nerve- 
fibres,  for  sensation  and  for  volition.  But,  it  will  be  said  that  there 
are  cases,  where  the  softening  was  so  considerable  that  the  mem- 
branes of  the  cord  contained  only  a  liquid,  which  flowed  out,  when 
the  membranes  were  opened.  This  also  has  no  value :  where  is 
the  proof  that  it  was  so  during  life?  Is  there  any  physician, 
knowing  the  facts,  published  by  Calmeil,2  and  which  demonstrate 
the  extremely  great  rapidity  of  production  of  softening,  which 
may  take  place  in  the  spinal  cord,  a  short  time  before  or  after 
death,  and  who  will  maintain  that  the  liquefaction  of  the  cord  had 
existed  previous  to  death,  without  causing  paralysis  ? 

2d.  As  to  the  cases  of  induration  of  the  spinal  cord,  the  same 
thing  may  be  said  as  for  cases  of  softening.  Until  it  is  shown 
that  in  cases  of  induration,  in  which  voluntary  movements  and 
sensibility  have  continued  to  exist,  there  was  a  complete  impossi- 
bility for  the  spinal  cord  to  perform  its  functions,  these  cases  will 
merely  prove  that  the  functions  of  this  organ,  may  remain,  although 
its  organization  appears  to  be  much  changed. 

3d.  We  will  show  elsewhere  that  the  same  reasoning  may  be 
applied  to  the  cases  in  which  the  transmission  of  nervous  action 
from  or  towards  the  brain  apparently  continued  to  take  place,  in 

1  Archives  Gen.  de  Medec,  vol.  vii. — 1825. 

2  Journal  des  Progres  des  Sciences  Medic,  1828,  vol.  xii.  p.  172. 


224  APPENDIX. 

the  spinal  cord,  although  it  was  much  atrophied,  in  consequence  of 
a  compression  or  any  other  cause. 

4th.  There  are  cases  in  which  it  is  said  that  the  spinal  cord  had 
been,  partly  or  entirely,  cut  across,  and  in  which  there  was  no 
paralysis  of  sensibility  or  voluntary  movement.  But  in  these  cases, 
the  section  had  taken  place  near  the  lower  extremity  of  the  spinal 
cord,  as  in  the  case  so  often  spoken  of,  recorded  by  Desault,1  so  that 
almost  all  the  nerves  had  their  origin  above  the  section.  Besides, 
when  a  sword  has  been  introduced  into  the  spinal  cord,  as  in  a 
curious  case  related  by  Ollivier  d'Angers,2  we  may  understand  that 
few  of  the  fibres  of  the  cord  had  been  cut  by  the  thin  extremity 
of  the  sword. 

We,  therefore,  will  conclude  that  the  facts  of  softening,  indura- 
tion, atrophy,  or  division  of  the  spinal  cord,  cannot  prove  against 
the  necessity  of  a  communication  of  the  encephalon  with  the  dif- 
ferent parts  of  the  body,  through  the  spinal  cord,  for  the  existence 
of  voluntary  movements  and  sensibility. 

3.  Alleged  persistence  of  sensibility  and  voluntary  movements  in  men 
and  animals,  deprived  of  all  the  'parts  of  the  encephalon,  except  the 
medulla  oblongata  and  the  pons  Varolii. 

The  facts  upon  which  physiologists  and  pathologists  have 
grounded  their  opinion  that  the  upper  parts  of  the  encephalon  are 
not  necessary  for  volition  and  for  the  perception  of  sensations  are 
of  two  kinds :  some  are  experimental,  some  clinical. 

As  to  the  experimental  facts,  they  consist  in  showing  that  after 
the  removal  of  the  encephalon,  except  the  pons  Varolii  and  medulla 
oblongata,  the  animals  manifest  that  they  feel  pain  by  their  cries 
and  agitation.  "When,"  says  Longet,3  "rabbits  and  dogs  have 
been  submitted  to  this  mutilation,  upon  their  encephalon,  although 
they  seem  to  be  in  a  deep  coma,  they  are  still  able  to  agitate  them- 
selves and  to  cry  plaintively,  under  the  influence  of  the  strong 
external  irritations ;  but,  if  a  sufficiently  deep  alteration  is  made, 
in  the  pons  Varolii,  there  is  an  immediate  cessation  of  the  cries 
and  of  the  agitation ;  it  merely  remains  an  animal,  in  whom  circu- 
lation, respiration,  and  other  nutritive  functions  are  momentarily 
accomplished." 

1  Journal  de  Chirurgie,  vol.  iv.  p.  137. 

2  Loco  cit.,  vol.  i.  p.  354. 

3  Traite  de  Physiol.,  1850,  vol.  ii.,  B.  p.  38. 


, 


EXAMINATION    OF    OBJECTIONS.  225 


Longet  concludes,  from  bis  experiments,  that  the  pons  Varolii 
the  seat  of  general  sensibility  (faculty  of  feeling  pain,  etc.),  and 
the  centre  for  the  perception  of  tactile  impressions.1  Of  these  two 
deductions  the  second  has  no  foundation  whatever;  there  is  not  a 
single  fact  which  may  even  appear  to  lead  to  it.  As  to  the  first 
deduction,  if  Lorry,  Magendie,  Desmoulins,  Bouillaud,  Gerdy, 
Serres,  J.  Mueller,  have  concluded,  as  Longet  did,  after  them,  that 
the  existence  of  cries  and  of  agitation,  in  animals,  deprived  of  all 
their  encephalon,  except  the  pons  Varolii  and  the  medulla  oblon- 
gata, proves  that  the  general  sensibility  then  exists — this  merely 
shows  that  these  eminent  physiologists  did  not  know  how  powerful 
may  be  the  reflex  power.2  Of  the  two  facts  given  as  proofs  of  a 
perception  of  sensation,  i.  e.,  agitation  and  cries,  the  first,  certainly, 
cannot  prove  that  there  has  been  a  perception  of  pain.  It  is  ex- 
actly the  same  thing  that  we  see  in  limbs,  connected  by  their 
nerves,  with  a  part  of  the  spinal  cord,  separated  from  the  ence- 
phalon. If,  in  this  case,  we  call  the  agitation  a  reflex  action,  why 
shall  we  give  to  it  another  name,  in  the  case  where  the  spinal  cord  is 
connected  with  the  medulla  oblongata  and  the  pons?  The  agita^ 
tion,  it  will  be  said,  is  greater  in  this  last  case,  but  the  extent  of 
the  nervous  centre,  able  to  produce  reflex  movements,  is  greater, 
so  that  these  movements  must  be  stronger  and  more  extensive. 

Now,  as  to  the  cries,  we  may  also  consider  them  as  mere  results 
of  reflex  contractions,  taking  place  in  certain  muscles.  The  vocal 
cords,  becoming  fixedly  stretched,  and  the  expiratory  muscles  con- 
tracting strongly  and  suddenly,  the  column  of  air  expelled  from 
the  chest  passes  along  the  stretched  vocal  cords,  and  vibrations 
take  place,  producing  the  sounds  we  call  cries.  I  have  seen  two 
hysteric  patients  who  cried  suddenly  (although  they  tried  not  to 
do  it),  after  the  slightest  irritation  of  the  skin,  or  after  any  kind  of 
emotion.3     It  seems,  then,  that  cries  may  be  considered  as  mere 

1  These  are  his  own  words,  loco  cit.,  pp.  36  to  41. 

2  It  may  seem  strange  that  I  declare  that  Prof.  J.  Mueller,  who  has,  in  common 
with  Marshall  Hall,  the  glory  of  having  called  the  attention  of  physiologists  and 
physicians  to  the  phenomena  of  reflex  action,  does  not,  nevertheless,  know  how 
great  may  he  the  power  of  the  reflex  faculty.  But,  to  prove  that  I  am  right,  I 
think  it  is  sufficient  to  say  that  Prof.  Mueller,  at  the  time  he  published  his  view 
on  the  pons  Varolii,  admitted  that  reflex  action  is  greater  in  cold  blooded  than  in 
warm  blooded  animals,  and  also  that  he  was  not  aware  how  much  pure  reflex 
movements  may  be  harmonious  and  well  co-ordinated. 

3  Dr.  R.  B.  Todd  has  given  some  good  reasons  to  show  that  the  pons  Varolii  is 
the  centre  for  emotional  movements  (Cyclop,  of  Anat.  and  Physiol.,  vol.  iii.  p. 

P 


226  APPENDIX. 

results  of  reflex  contractions.  I  must,  nevertheless,  say  that  I  do 
not  think  that  the  question  is  positively  decided.  My  only  object 
now  is  to  show  that  cries  cannot  prove  that  sensibility  exists, 
because  we  may  explain  them,  without  admitting  that  pain  has 
been  truly  felt. 

All  the  writers  on  this  subject,  already  named,  had  considered 
the  pons  Varolii  as  being  the  organ  in  which  the  perception  of 
sensitive  impressions  take  place,  and  they  agree  in  saying  that, 
after  the  removal  of  the  pons,  there  are  no  more  cries.  They  have 
been  mistaken  about  this  last  fact,  and  I  have  obtained  quite  a 
different  result,  in  performing  this  experiment  on  cats,  rabbits,  and 
guinea-pigs.  After  having  removed,  by  slices,  the  whole  ence- 
phalon,  except  only  the  medulla  oblongata,  I  have  observed  that 
the  animal,  when  pinched,  is  much  agitated,  and  that  it  cries  plain- 
tively. Then,  if  the  medulla  oblongata  is  removed,  there  are  no 
more  cries,  when  the  animal  is  pinched,  but  the  agitation  continues.1 
There  is  great  appearance  that,  after  this  mutilation,  cries  would 
exist  if  the  motor  nerves  of  the  larynx,  instead  of  being  connected 
with  the  medulla  oblongata,  were  connected  with  the  spinal  cord. 
Of  the  two  things  necessary  for  cries,  one  exists:  the  animal,  being 
pinched,  not  only  has  agitation  of  the  limbs  and  trunk,  but  a  con- 
traction of  the  expiratory  muscles.  Elourens2  had  already  seen 
that  there  may  be  a  respiratory  movement,  in  such  cases,  and  he 
says  that  a  true  inspiration,  producing  a  sound  in  the  larynx,  exists 
when  the  animal  is  pinched. 

722,  q).  I  am  ready  to  admit  that  tlie  pons  Varolii,  particularly  by  its  part  con- 
nected with  the  roots  of  the  auditive  nerve,  is  a  portion  of  the  centre  of  emotional 
movements,  but  not  the  seat  of  the  whole  of  this  centre.  The  medulla  oblongata, 
I  think,  is  also  a  part  of  this  centre.  When  a  violent  and  sudden  emotion  causes 
death,  it  is  in  acting  on  the  medulla  oblongata,  that  it  has  such  a  powerful  effect. 
An  excitation  is  then  produced  on  the  roots  of  the  par  i-agum,  which  appear  to  have 
their  true  origin  in  the  neighborhood  of  the  nib  of  the  calamus  scriptorius,  and  in 
consequence,  the  bloodvessels  of  the  heart  contract  and  expel  the  blood  they  con- 
tained, and  with  it,  the  natural  excitant  which  causes  the  movements  of  the  heart. 
So  that  a  complete  syncope  and  death  take  place.  It  is  in  acting  on  the  branches 
of  the  par  vagum,  in  the  lungs,  as  I  will  prove  elsewhere,  or  on  the  medulla  oblon- 
gata, that  chloroform  sometimes  kills  suddenly.  The  stopping  of  the  heart's  action 
in  the  celebrated  experiment  of  the  brothers  Weber,  takes  place  in  the  same  way, 
as  I  have  tried  to  prove  in  my  Exp.  Researches,  p.  77,  and  pp.  101  to  124. 

1  These  experiments  I  had  already  published,  in  the  Comptes  Rendus  de  l'Acad. 
des  Sciences,  1849,  vol.  xxix.  p.  672. 

2  Rech.  Exper.  sur  les  Propr.  et  les  Fonct.  du  Syst.  Nerveux,  2d  ed.,  1S42,  p. 
178. 


EXAMINATION    OF    OBJECTIONS.  227 

Now  we  will  conclude  that,  if  cries  prove  that  there  is  percep- 
tion of  pain,  we  must  admit,  it  opposition  to  all  the  physiologists 
already  named,  that  the  medulla  oblongata  is  a  centre  for  that  kind 
of  perception.  Besides,  the  view  of  these  physiologists,  as  regards 
the  pons  Varolii,  is  erroneous.  Still  more,  if  agitation  proves  that 
sensibility  exists,  the  spinal  cord  possesses  this  faculty,  as  well  as 
the  encephalon.  But  we  repeat  that  the  reflex  theory  explains  the 
existence  of  agitation  and  of  cries,  and  we  are  not,  therefore,  com- 
pelled to  admit  that  the  spinal  cord  and  the  medulla  oblongata 
possess  sensibility. 

The  luill,  or  at  least  the  faculty  under  the  influence  of  the  will, 
and  by  which  the  so-called  voluntary  movements  are  produced,  is 
considered  also  by  Gerdy,  Mueller,  Longet,  and  others,  as  having 
its  organ  in  the  pons  Varolii  and  in  the  brain.  The  reasons  given 
by  these  writers  to  prove  their  views  are  far  from  being  satisfactory. 
They  prove  merely  that  there  are  energetic  movements  after  an 
excitation  of  the  animal,  and  these  appear  then  to  be  mere  reflex 
movements.  Longet  himself  (he.  cit.,  p.  39)  says,  that  if  the  cere- 
bral hemispheres  have  been  removed,  and  also  the  corpora  striata, 
in  rabbits,  they  can  stand  up  or  move  forwards,  but  that  after  the 
removal  of  the  thalami  optici,  although  the  pons  Varolii  is  left 
entire,  there  is  no  more  possibility  for  the  animal  to  walk  or  to 
stand  up. 

I  have  many  times  repeated  these  experiments  upon  rabbits  and 
guinea-pigs,  and  uniformly  obtained  nearly  the  same  results,  which 
certainly  are  a  deadly  blow  to  the  theory  advocated  by  Longet. 
Not  only  standing  and  walking  become  impossible  after  the  re- 
moval of  the  whole  encephalon,  except  the  pons  and  the  medulla 
oblongata,  but  it  seems  also  that  the  apparently  spontaneous  move- 
ments which  sometimes  exist  there,  are  mere  convulsive  move- 
ments. 

Besides,  I  have  found  that  the  reflex  movements  in  this  case  are 
only  a  little  stronger  than  in  animals  deprived  of  the  pons  Varolii. 
As  to  the  regularity,  the  harmony,  the  direction  of  the  reflex 
movements,  they  are  alike  in  both  cases. 

The  celebrated  doctrine  of  Flourens,  against  which  Bouillaud, 
Gerdy,  Longet,  and  others  had  proposed  the  theory,  which  I  have 
just  proved  to  be  erroneous,  does  not  appear  to  be  right.  Flourens 
has  gone  too  far,  I  believe,  in  thinking  that  the  faculty  of  percep- 
tion for  all  the  sensitive  and  the  sensorial  impressions  exists  only 
in  the  cerebral  lobes,  and  that  the  same  parts  are  also  the  only  seat 


228  APPEXDIX. 

of  intelligence  and  volition.  We  will  not  discuss  these  questions 
here,  but  we  will  say,  as  regards  the  perception  of  sensitive  im- 
pressions and  volition,  that  experiments  on  animals,  as  well  as 
pathological  facts  observed  in  man,  and  also  microscopic  anatomy, 
agree  in  showing  that  the  thalami  optici  and  the  corpora  striata, 
and  also  the  crura  cerebri,  appear  to  be  the  centres  for  these 
actions.  I  am  glad  to  agree  almost  entirely  with  Dr.  Todd,  as 
regards  the  corpora  striata,  which  he  considers  as  the  principal 
centres  for  voluntary  movements.  But  I  do  not  agree  with  him 
as  to  the  thalami  optici,  which,  according  to  his  views,  are  the 
centres  for  almost  all  the  sensitive  and  sensorial  nerves.  Anatomy 
and  pathology  are  opposed  to  this  view,  as  I  will  try  to  show  in  a 
special  paper. 

.  There  are  on  record  many  cases  of  acephalia  or  of  anencephalia, 
which  might  be  considered  as  proving  that  sensibility  and  volun- 
tary movements  may  exist,  when  the  whole  encephalon  is  missing, 
except  the  medulla  oblougata  alone  or  with  the  pons  Varolii.  In 
all  the  cases  of  this  kind  which  I  have  collected,  I  have  found  no 
evidence  that  the  movements  which  existed  were  voluntary  and 
not  simply  reflex  or  convulsive.  I  will  give  here  a  short  analysis 
of  two,  among  these  cases,  which  appear  to  be  the  most  favorable 
to  the  theory  I  reject. 

Case  1. — I  have  seen,  says  Lallemand,1  an  encephalous  foetus, 
born  at  full  time,  and  which  lived  three  days.  During  all  this 
time  it  cried  with  a  certain  degree  of  strength,  and  tried  to  suck 
whenever  anything  was  put  between  its  lips.  It  made  movements 
to  some  extent  with  its  legs  and  arms.  When  anything  was  put 
in  its  hands,  there  was  a  flexion  of  its  fingers,  as  though  it  would 
seize  it,  but  generally  all  its  movements  were  less  energetic  than 
those  of  a  healthy  foetus  of  the  same  age. 

The  cerebrum  and  the  cerebellum  were  entirely  missing;  there 
were  only,  on  the  basis  of  the  cranium,  the  medulla  oblongata  and 
the  pons  Varolii,  with  the  origin  of  the  pneumogastric,  trigeminal, 
and  optic  nerves.2 

1  Loco  cit.,  p.  52. 

2  Lallemand,  in  this  description,  lias  not  shown  the  accuracy  which  ordinarily 
characterizes  his  publications.  He  says  that  the  optic  nerves  had  their  origin  in 
the  parts  that  remained  of  the  encephalon ;  this  implies,  certainly,  that  some 
parts,  at  least,  of  the  tubercula  quadrigemina  were  also  existing,  although  he  does 
not  mention  it. 


EXAMINATION"    OF    OBJECTIONS.  229 

Although  Lallemand  concludes  from  this  fact  that  sensibility  and 
voluntary  movements  existed  in  this  monster,  no  one  acquainted 
with  reflex  action  will  accept  these  deductions. 

Case  2. — A  foetus  nine  months  old  was  born  perfectly  well 
developed,  except  that  it  was  anencephalous.  Its  eyes  were  con- 
stantly shut;  it  frequently  uttered  cries,  that  ceased  when  a  finger 
was  put  in  its  mouth;  it  then  sucked  repeatedly.1  Its  limbs  were 
agitated  with  some  strength,  and  it  pressed  with  its  fingers  the 
things  that  were  placed  in  its  hands.  Three  hours  after  birth,  the 
number  of  respirations  in  a  given  time  was  diminished,  and  the 
cries  were  less  frequent  and  less  strong.  Respiration  diminished 
gradually  and  became  convulsive.  This  state  lasted  for  six  or 
eight  hours,  during  which  the  cries  became  weaker  and  weaker, 
and  less  frequent,  as  also  the  respiratory  movements,  which  were 
accompanied  with  general  convulsions,  and  at  last  it  died  in  a  true 
state  of  asphyxia.  The  cerebrum  and  the  cerebellum  were  entirely 
missing,  and  of  the  basis  of  the  encephalon  nothing  existed  except 
a  very  irregular  medulla  oblongata,  connected  with  a  kind  of  pons 
Varolii,  merely  consisting  in  a  square  layer  of  gray  matter  only 
two  lines  and  a  half  long  and  two  lines  broad.  The  membranes  of 
the  spinal  cord  were  inflamed. 

This  case,  recorded  by  Ollivier  d' Angers,2  and  considered  by  him 
as  proving  that  the  spinal  cord  and  the  medulla  oblongata  possess 
the  two  faculties  of  perception  of  sensitive  impressions  and  of  voli- 
tion, certainly  cannot  prove  such  things.  Had  Ollivier  known 
reflex  action,  he  would  have  considered  this  case  quite  in  another 
light.  But  there  is  something  important  proved  by  this  fact,  and 
which  is  entirely  opposed  to  the  view  of  Gerdy,  Mueller,  Longet, 
and  others;  it  is  that  the  pons  Varolii  was  so  slightly  developed, 
that  we  can  consider  it  as  missing,  and,  nevertheless,  agitation  and 
cries  have  existed  as  when  the  pons  exist.  If  these  phenomena 
prove  that  sensibility  and  volition  exist,  we  must  then  admit  that 

1  Suckling  in  anencephalic  monsters  may  take  place,  as  it  takes  place,  also,  in 
animals  deprived  of  almost  all  their  encephalon.  This  fact  has  been  well  proved 
by  the  experiments  of  Grainger  (Observ.  on  the  Struct,  and  Funct.  of  the  Spinal 
Cord,  1837,  p.  80),  of  J.  Reid  (Physiol.  Anat.  and  Pathol.  Researches,  1848,  p.  183), 
and  by  my  own  (Exp.  Res.  applied  to  Physiol.,  etc.,  1853,  p.  5).  Grainger  has 
also  well  proved  that  sucking  is  a  mere  reflex  action,  by  pointing  out  what  takes 
place  in  the  foetus  of  the  opossum,  in  which  sensation  and  volition  cannot  exist, 
and  the  lips  of  which  remain  attached  to  the  nipple  by  contraction  and  grasping. 

2  Loco  cit.,  vol.  i.  p.  179. 


230  APPENDIX. 

the  pons  Varolii  and  the  cerebrum  are  not  the  only  centres  for 
volition  and  for  perception  of  sensitive  impressions. 

To  conclude,  we  will  say  that  both  monsters  and  animals  experi- 
mented upon,  may  cry  and  have  movements,  when  they  are  de- 
prived of  almost  all  their  encephalon  (the  medulla  oblongata  alone 
remaining),  but  that  nothing  proves  that  these  movements  and 
these  cries  are  not  mere  reflex  actions. 

In  other  words,  the  facts,  which  have  been  considered  by  almost 
all  the  French  physiologists  of  our  day,  as  proving  that  the  pons 
Varolii  is  a  centre  for  volition  and  sensibility,  cannot  prove  such 
a  thing.  Besides,  it  is  clear,  also,  that  these  facts  cannot  prove 
anything  against  the  theory  that,  in  men  and  animals,  having  their 
nervous  centres  well  developed,  transmission,  for  both  sensations 
and  volitions,  has  to  take  place  through  the  medulla  oblongata 
and  the  pons  Varolii. 

4.  On  cases  proving  that  considerable  alterations  of  the  Pons  Varolii 
and  Medulla  Oblongata  may  exist  without  producing  parcdysis  either 
of  sensibility  or  of  voluntary  movements. 

"We  have  collected  a  large  number  of  such  cases,  mostly  relative 
to  the  medulla  oblongata.  It  is  strange  that  this  nervous  centre, 
which  is  considered  so  much  more  important  than  any  other,  is  so 
frequently  altered,  and  sometimes  extremely,  without  producing 
either  death  or  even  a  decided  paralysis. 

It  is  strange,  also,  that  slow  alterations  of  the  pons  Varolii,  which 
is  considered  notably  less  useful  than  the  preceding  organ,  produce 
more  frequently  a  paralysis,  and  this  even  when  these  alterations 
are  less  considerable  than  alterations  of  the  medulla  oblongata, 
which  do  not  produce  paralysis.  This  seems  still  more  strange 
when  we  remember  that  very  rapid  or  sudden  alterations  kill  more 
quickly  when  developed  in  the  medulla  oblongata  than  in  the  pons 
Varolii. 

I  will  relate  here  as  specimens,  some  few  cases  of  alteration  of 
both  of  these  organs,  to  show  how  far  such  alterations  may  go 
without  producing  paralysis. 

Case  1. — A  patient  had  had — only  during  the  last  days  of  her 
life — all  the  symptoms  of  a  cerebral  compression,  such  as  suspen- 
sion of  intelligence,  stertorous  respiration,  sometimes  deep  groan- 
ing, slight  spasms  and  involuntary  movements. 


EXAMINATION    OF    OBJECTIONS.  231 

Autopsy. — There  was  no  alteration  of  the  brain  and  cerebellum. 
The  volume  of  the  pons  Varolii  was  almost  doubled.  It  contained 
an  encysted  tubercle,  with  a  smooth  surface,  not  adhering  to  the 
nervous  matter.  The  size  of  the  cyst  was  that  of  a  big  walnut. 
A  part  of  the  tubercle  was  dense  and  lardaceous,  the  centre  was 
softer.1 

Case  2. — A  man,  aged  63,  died  of  acute  pnuemonia.  He  had 
been  epileptic  for  twelve  years ;  each  fit  began  with  very  violent 
hiccups,  lasting  one  or  two  minutes,  and  accompanied  with  a  sensa- 
tion of  a  ball  going  up  from  the  stomach  to  the  pharynx.  All  the 
liquids  that  were  then  given  to  him  were  violently  expelled.  To 
this  state  succeeded  a  loss  of  consciousness,  which  lasted  two  or 
three  minutes,  and  then  all  the  accidents  passed  away.  This  con- 
vulsive and  momentary  spasm  used  to  come  every  fifteen  days,  and 
some  physicians  had  considered  it  as  very  different  from  epilepsy. 
During  the  fits  the  loss  of  sensibility  was  complete. 

Autopsij. — The  brain  and  the  cerebellum  were  normal;  but,  in 
the  middle  of  the  substance  of  the  medulla  oblongata,  two  tubercles 
were  found :  one  as  large  as  a  small  walnut,  and  the  other  the  size 
of  a  filbert ;  they  were  adhering  to  each  other,  and  each  of  them 
was  in  a  very  thin  cyst.  The  medullary  substance  around  them 
was  not  altered.2 

These  two  cases  show  that,  although  there  is  a  diminution  in  the 
number  of  fibres  which  establish  a  communication  between  the 
spinal  cord  and  the  parts  of  the  encephalon  anterior  to  the  medulla 
oblongata  and  to  the  pons  Yarolii,  sensibility  and  voluntary  move- 
ments may  continue  to  exist,  at  least  until  a  short  time  before 
death.  We  are  led  by  the  fact  that  there  is  a  number  of  fibres 
which  are  then  destroyed  in  a  part  of  their  length,  to  admit  one  or 
the  other  of  the  two  following  opinions. 

1st.  The  nerve-fibres  of  the  pons  and  the  medulla  oblongata  are 
not  necessary  channels  of  communication  between  the  spinal  cord 
and  the  parts  of  the  encephalon  anterior  to  the  pons.  I  think  no 
one  will  admit  such  an  opinion,  which  is  in  complete  opposition 
with  almost  all  that  is  taught  by  physiology  and  pathology,  as  re- 
gards the  nervous  centres. 

1  Traits  de  la  maladie  scrofuleuse,  par  Lepelletier,  p.  129. 

2  This  case  was  recorded  by  Gendrin.  See  Traite  des  Maladies  de  la  Moelle  epin., 
par  Ollivier  d'Angers.     Vol.  ii.  p.  518. 


232  APPENDIX. 

2d.  We  can  explain  the  facts  by  another  hypothesis.  Suppose 
that  the  divided  extremities  of  the  destroyed  fibres  become  con- 
nected with  either  the  tails  or  the  envelop  of  some  caudate  or 
bipolar  cells,  and  that  by  the  means  of  the  fibres  originating  from 
these  cells,  communication  may  continue  from  below  upwards  and 
from  above  downwards ;  if  such  a  reunion  takes  place  between  the 
extremities  of  divided  fibres,  below  and  above  the  seat  of  the  com- 
pression or  of  the  alteration,  although  there  is  no  decided  paralysis, 
there  must  be  much  inaccuracy  in  the  action  of  the  will  on  the 
muscles,  .because  certain  muscles  must  be  put  in  action  at  a  time 
when  the  will  does  not  wish  for  their  contraction.  As  to  sensa- 
tions, if  their  intensity  is  not  diminished,  there  must  be  a  diminu- 
tion in  the  faculty  of  determining  from  where  an  impression  comes. 
These  two  kinds  of  changes,  in  voluntary  movements  and  in  sensi- 
bility, are  very  frequent  in  incipient  paralysis,  whatever  may  be 
the  seat,  in  the  encephalon,  of  the  alteration  which  causes  it.  Yery 
likely  these  changes  are  produced  by  the  same  anatomical  causes, 
whatever  is  the  seat  of  the  disease.1 

It  may  be  said,  that  when  a  tumor  presses  upon  a  nervous  centre, 
it  may  not  destroy  the  fibres  and  merely  separate  them  one  from 
the  other  and  render  them  thinner.  This  certainly  ought  to  take 
place;  but  besides  this,  a  partial  destruction  must  also  exist  in 
cases  where  a  tumor  becomes  extremely  large,  and  particularly  if 
it  exists  in  a  relatively  narrow  place,  as  is  the  case  in  the  vertebral 
canal,  for  the  medulla  oblongata  and  a  part  of  the  pons  Varolii, 
compared  to  other  parts  of  the  encephalon.  Another  cause  of  the 
slight  influence  of  tumors,  in  these  nervous  centres  upon  voluntary 
movements  and  sensibility,  is  that  the  conductors  employed  in  the 
transmission  of  sensitive  impressions  and  of  the  orders  of  the  will 
to  muscles  are  but  a  small  part  of  these  centres  and  that,  therefore, 
a  considerable  alteration  may  exist  in  them,  with  but  little  injury 
to  these  conductors.  (See  Lecture  XII.) 

I  wish  I  had  room  here  to  publish  the  very  interesting  and 
numerous  cases  I  have  collected,2  and  which  show  that  the  pons 

1  The  cases  of  disordered  movements,  recently  published  by  Landry  and  Du- 
chenne,  and  which  they  explain  in  admitting  that  a  pretended  faculty  of  co-ordi- 
nation has  been  lost,  are  most  frequently  due  to  the  cause  above  mentioned. 

2  With  the  exception  of  two  or  three  of  these  cases,  I  have  borrowed  them  from 
modern  writers.  As  a  guarantee  of  the  exactitude  of  observation,  I  give  here  a 
list  of  the  most  known  among  these  writers  :  Bouillaud,  Cruveilhier,  Gendrin,  J. 
Cloquet,  Duverney,  Gama,  Esquirol,  Stanley,  Lieutaud,  Lenhossek,  Romberg,  Aber- 


EXAMINATION    OF    OBJECTIONS.  233 

Varolii  and  the  medulla  oblongata  may  be  compressed,  and  some- 
times as  much  as  to  be  reduced  to  one-half  or  one-third  of  their 
size,  if  not  more,  although  there  is  hardly  any  paralysis  produced, 
except  during  the  last  days  of  life.  These  facts  are  extremely  in- 
teresting in  a  pathological  as  well  as  in  a  physiological  point  of 
view. 

There  is  one  thing  which  appears  to  be  well  proved  by  these 
facts,  and  especially  by  those  in  which  a  layer  only  of  white  matter 
has  been  left  either  in  the  medulla  oblongata  or  in  the  pons  Varolii, 
it  is  that  these  organs  are  neither  the  centre  nor  an  important  part 
of  the  centre,  for  volition  or  for  perception  of  the  sensitive  impres- 
sions ;  because  if  they  were,  these  faculties  should  be  lost.  We 
may  understand  that  the  power  of  transmission  of  nervous  actions 
(either  for  sensations  or  for  volitions)  may  be  kept  in  a  part  where 
there  remains  only  some  fibres,  but  the  higher  faculties  of  percep- 
tion and  volition  would  certainly  be  destroyed,  had  they  their  seat 
in  organs  so  much  altered  as  the  pons  and  the  medulla  oblongata 
sometimes  are. 

As  these  pathological  cases  might  be  considered  as  proving  that 
communications  between  the  spinal  cord  and  the  parts  of  the  ence- 
phalon  anterior  to  the  pons,  are  not  necessary  for  the  performance 
of  voluntary  movements  and  for  the  perception  of  sensitive  impres- 
sions, and  as  such  a  conclusion  might  also  be  drawn  from  the  result 
of  certain  experiments,  recently  published,  I  think  I  ought  to  ex- 
amine here  these  experiments.  It  is  certainly  important  to  make 
this  examination  and  to  show  that  such  a  conclusion  is  not  right, 
because,  were  it  admitted  to  be  correct,  all  the  researches  and  con- 
clusions exposed  in  our  Lectures,  concerning  the  region  where  the 
decussation  of  the  voluntary  motor  and  sensitive  nerve-fibres  takes 
place  in  the  nervous  centres,  would  almost  become  useless  and 
without  meaning. 

Two  French  physiologists,  Drs.  Vulpian  and  Philipeaux,1  relate 
some  experiments,  in  one  of  which  they  had  divided  transversely  a 
lateral  half  of  the  medulla  oblongata,  about  one  line  in  front  of  the 
nib  of  the  calamus  scriptorius.  The  result,  as  stated  by  the  authors, 
was:  conservation  of  the  voluntary  movements  and  of  sensibility 
in  the  two  sides  of  the  body. 

crombie,  Velpeau,  Guersant,  Rilliet,  Barthez,  Bayle,  Hutin,  Pariset,  Burnet,  Ollivier 
d'Angers,  Lebert,  Bright,  etc. 

1  Essai  sur  l'origiue  de  plus,  paires  des  nerfs  craniens,  1853,  p.  54. 


234:  APPENDIX. 

As  regards  voluntary  movements,  the  experimenters  themselves 
say  that  the  animals  could  not  stand  on  their  feet,  but  they  consider 
as  a  voluntary  action,  a  great  agitation  of  the  four  limbs,  consisting 
in  alternative  flexious  and  extensions.  I  will,  first,  remark  that 
the  experiment  cannot  prove  much  about  voluntary  movements, 
because  the  section  has  been  made  on  the  decussation  of  the 
pyramids,  leaving  there,  undivided,  a  number  of  voluntary  motor 
fibres  belonging  to  the  two  sides  of  the  body.  We  certainly  might 
consider  the  agitation  as  voluntary  and  produced  by  the  undivided 
fibres.  But  we  have  found  that  if  the  lateral  hemisection  of  the 
medulla  oblongata  is  made  a  little  higher,  i.  e.  above  the  decussation, 
so  that  only  the  voluntary  motor  fibres  of  the  opposite  side  of  the 
body  have  been  divided,  there  is,  also,  agitation  on  both  sides, 
though  much  more  on  the  side  of  the  section.  But  this  agitation 
is  not  a  voluntary  action;  it  is  convulsive,  as  will  be  shown  hereafter. 

Before  any  division  of  the  medulla  oblongata,  and  even  before 
having  laid  it  bare,  the  mere  fact  of  having  divided  a  number  of 
the  muscles  of  the  posterior  part  of  the  neck,  as  Longet  has  found, 
is  followed  by  a  very  great  agitation  in  the  whole  body,  at  every 
time  the  animal  attempts  to  move.  This  trouble  comes  from  the 
fact  that  the  head,  being  drawn,  by  the  contraction  of  the  anterior 
muscles  of  the  neck,  towards  the  sternum,  the  medulla  oblongata 
is  drawn  upwards  and  excited,  and  so  are  the  spinal  cord  and  its 
nerves.  Now,  after  the  section  of  a  lateral  half  of  the  medulla 
oblongata,  this  irritation  of  all  the  intra-spinal  nervous  system 
continues  and  only  changes  somewhat  in  nature,  precisely  because 
the  will  cannot  act,  as  well  as  before,  to  diminish  the  agitation. 
This  is  one  cause  of  agitation,  but  not  the  only  one;  there  is 
another  in  the  irritation  existing  in  the  wound.  Besides,  the 
animal,  upon  which  a  section  of  a  lateral  half  of  the  medulla 
oblongata  has  been  performed,  is  attacked  with  this  peculiar  and 
so  curious  convulsive  affection,  which  manifests  itself  by  a  rotatory 
movement  (see  Lecture  XII.,  and  my  Exper.  Researches,  p.  18  to  23), 
and  we  well  know  that,  in  man,  this  rotation  is  never  voluntary, 
and  that  when  it  takes  place  in  a  man  who  has  his  consciousness 
entire,  the  rotation  occurs,  although  the  will  tries  to  prevent  it. 
Therefore  the  agitation  of  an  animal,  upon  which  a  lateral  half  of 
the  medulla  oblongata  has  been  cut,  cannot  be  considered  as  a 
voluntary  action.  It  may  be  partly  voluntary,  in  one  side  of  the 
body,  when  the  section  is  made  above  the  decussation  of  the  pyra- 


EXAMINATION    OF    OBJECTIONS.  235 

mids,  but  then  we  have  merely  a  confirmation  of  the  facts  and  con- 
clusions exposed  in  our  Lectures. 

As  to  sensibility,  I  need  not  say  much.  I  had  myself  published, 
long  ago,  that  a  section  of  a  lateral  half  of  the  medulla  oblongata, 
above  the  roots  of  the  pneumogastric  nerves,  does  not  appear  to 
destroy  sensibility,  if  we  decide  that  the  existence  of  this  faculty  is 
proved,  there  are  cries  and  agitation,  as  have  done  Drs.  Yulpian  and 
Philipeaux.  I  had  gone  farther  and  shown  that  if,  instead  of 
merely  cutting  a  lateral  half  of  the  medulla  oblongata,  we  divide 
this  organ  entirely,  where  it  unites  with  the  pons  Varolii  (as  we 
have  already  said  in  a  preceding  section  of  this  paper),  sensibility 
ajjpears  to  exist  everywhere,  i.  e.  agitation  and  cries  are  observed 
after  every  excitation.  But,  as  long  as  it  will  not  be  proved  that 
cries  and  agitation  are  not  mere  reflex  actions,  we  are  entitled  to 
consider  them  as  such.  Drs.  V.  and  P.  say  that  the  animals,  upon 
which  they  had  cut  a  lateral  half  of  the  medulla  oblongata,  appeared 
to  be  more  sensitive  than  normally.  We  agree  partly  with  them : 
there  is  an  apparent  increase  of  sensibility,  but  much  more  marked 
in  the  side  of  the  operation. 

Nearly  the  same  results  are  obtained,  as  regards  sensibility, 
whether  the  hemisection  is  made  on  the  medulla  oblongata  or  on 
the  pons  Varolii. 

It  is  known  that  there  is  a  question,  connected  with  our  subject, 
which  has  been  the  cause  of  great  discussion  between  Flourens, 
Calmeil,  Ollivier  d'Angers,  Longet  and  others.  This  hitherto 
qucestio  vexata  is  no  more  a  question,  after  what  we  have  said  in 
our  Lectures  on  the  place  of  decussation  of  the  nervous  conductors 
for  volition  and  sensation.  The  question  was  whether  the  medulla 
oblongata  has  a  crossed  action  for  sensibility  and  voluntary  move- 
ment. The  solution  is,  I  believe,  given  in  our  Lectures  III.,  VI. 
and  XII.,  and  as  to  the  reasons  for  which  there  has  been  discre- 
pancies of  opinions,  what  we  have  just  said  of  the  experiments  of 
Drs.  Vulpian  and  Philipeaux,  explains  how  the  erroneous  and  con- 
trary results  of  the  various  experimenters  may  have  been  obtained. 

To  conclude  on  this  subject,  I  will  say  that  the  experiments  of 
these  two  physiologists  and  the  pathological  cases,  in  which, 
although  there  was  a  considerable  alteration  of  the  pons  or  of  the 
medulla  oblongata,  no  decided  paralysis  existed — are  certainly  not 
able  to  prove  against  our  admitting  that  a  communication,  by 
voluntary  motor  and  by  sensitive  fibres,  is  necessary  between  the 
spinal  cord  and  the  parts  of  the  encephalon  anterior  to  the  pons. 


236  APPENDIX. 

The  Dumber  of  fibres  establishing  the  communication  may  diminish, 
■without  any  notable  diminution  in  the  intensity  of  sensations  and 
in  the  strength  of  voluntary  movements.  But,  it  seems  that  in 
such  cases,  there  ought  to  be  an  alteration  in  the  harmony  and 
regularity  of  the  voluntary  movements,  and  in  the  power  of  judging 
from  what  place  comes  a  sensitive  impression. 

5.  Cases  in  which  an  alteration  in  the  two  sides  of  the  pons  Varolii 
appeared  to  have  produced  a  paralysis  only  in  one  side  of  the  body, 

I  know  of  no  case  where  the  pons,  being  much  and  equally 
altered,  on  both  sides,  there  has  been  a  mere  hemiplegia;  but  there 
are  some  cases,  in  which  an  alteration,  more  considerable  on  one 
side  than  in  the  other,  has  produced  paralysis  in  one  side  only  of 
the  body,  which  side  has  been  that  opposed  to  the  most  altered  in 
the  pons.  Such  facts  cannot  prove  more  than  the  facts  above 
related,  in  which  an  alteration  has  existed  on  both  sides  of  the 
pons  without  producing  paralysis.  There  is  a  case,  however, 
published  by  Mr.  Huguier  {Bulletin  de  la  Soc.  Anat,  1829,  p.  52) 
in  which  it  is  stated  that  a  tubercle,  the  size  of  a  walnut,  was 
placed  on  the  middle  line  against  the  anterior  surface  of  the  pons 
Varolii,  separating  the  two  crura-cerebri  and  producing  paralysis 
only  in  the  right  side  of  the  body.  Had  the  autopsy  been  made 
with  more  care,  it  would  have  been  observed  that  the  alteration  of 
the  left  crus  was  deeper  than  that  of  the  right,  or  that  there  was 
some  other  cause  to  the  hemiplegia. 

6.  Cases  in  which  an  alteration  existing  in  one  side  of  the  pons  Varolii, 
or  in  the  neighboring  parts,  appears  to  have  produced  paralysis  in 
loth  sides  of  the  body. 

There  are  some  cases  of  this  kind  on  record ;  but  they  cannot 
prove  much,  because  an  alteration  in  structure,  sufficient  to  produce 
paralysis,  may  extend  to  a  certain  distance  from  the  side  of  the 
pons,  where  is  a  tumor,  to  the  other  side.  Now,  many  alterations 
may  escape  the  search,  made  with  the  naked  eye,  and,  as  a  tumor 
is  found,  observers  have  thought  its  existence  was  sufficient  to 
explain  the  symptoms  observed  before  death. 

I  will  give  here  only  a  short  analysis  of  two  cases  of  this  kind, 
which  I  find  in  the  remarkable  work  of  my  friend,  Prof.  Lebert, 

Traite  pratique  des  maladies  cancereuses,  1851,  p.  806. 


EXAMINATION    OF    OBJECTIONS.  237 

Case  1. — Headache,  blindness,  pupils  dilated,  weakness  and 
rigidity  of  the  limbs,  tetaniform  contracture  of  the  trunk,  con- 
vulsions, respiration  difficult  and  noisy,  speech  embarrassed,  death. 

Autopsy. — Tumor  of  the  anterior  part  of  the  left  lobe  of  the  cere- 
bellum, which  had  pushed  the  pons  Varolii  and  made,  in  its  ante- 
rior part,  a  cavity,  in  which  it  was  lodged. 

Case  2. — Cephalalgia;  not  long  before  death,  hemiplegia  left 
side ;  incomplete  paralysis  of  the  right  side ;  contracture,  frequent 
shaking;  lancinating  and  great  pain  in  the  left  limbs;  at  last,  in- 
voluntary expulsion  of  urine  and  fecal  matters. 

Autopsy. — A  tumor,  not  larger  than  a  pea,  is  found  in  the  middle 
and  inferior  part  of  the  right  side  of  the  pons. 

No  physician,  acquainted  with  nervous  diseases,  will  believe  that 
in  such  a  case  there  was  no  other  alteration,  besides  the  slight  dis- 
placement or  compression  of  nervous  matter,  in  the  immediate 
neighborhood  of  so  small  a  tumor.  The  following  fact  will  show 
that  when  an  alteration  appears  to  exist  only  in  one  side  of  the 
encephalon,  when  there  has  been  paralysis,  in  the  two  sides  of  the 
body,  the  microscope  is  necessary  to  decide  if  there  is  no  other 
alteration  more  able  to  give  us  the  reason  of  the  double  paralysis. 

This  fact  is  so  important,  that  I  will  give  it  with  all  the  details, 
and  in  the  very  words  of  Prof.  Hughes  Bennett,  who  has  related  it. 
"  Another  well  remarked  case  was  that  of  a  man  who  entered  the 
Infirmary,  under  Dr.  Paterson,  in  1842.  All  the  symptoms  of  acute 
softening  were  present ;  paralysis  of  the  left  side,  including  rigidity 
and  contraction  of  the  left  arm,  dulness  of  intellect,  and  tonic 
spasms  of  the  muscles  of  the  mouth  and  neck.  The  right  side  was 
also  affected  in  a  slighter  degree.  As  the  case  excited  considerable 
interest,  great  care  was  taken  in  examining  the  brain.  When  the 
lateral  ventricles  were  opened,  it  became  a  question  whether  the 
right  corpus  striatum  was  softened.  Several  persons  applied  their 
fingers,  and  endeavored  to  ascertain  the  point.  As  the  manual 
examination  proceeded,  the  normal  consistence  of  the  part  dimi- 
nished, until  at  length  it  presented  all  the  appearance  of  pultaceous 
softening.  In  this  state  it  was  shown  to  Dr.  Paterson,  who  naturally 
enough  considered  it  to  be  the  result  of  disease.  I  differed  from 
him  in  opinion  :  first,  because  I  had  carefully  observed  the  gradual 
increase  of  the  softening  in  the  manner  alluded  to ;  and  secondly, 
because  disease  of  the  corpus  striatum,  in  one  side  of  the  brain, 


238  APPENDIX. 

could  not  Lave  explained  the  well-marked  symptoms  which  existed 
on  both  sides  of  the  body.  When  the  pons  Varolii  was  bisected, 
Dr.  Peacock,  who  conducted  the  examination,  conceived  it  to  be 
softened ;  others  who  examined  it,  could  perceive  no  difference  in 
the  texture;  its  color  and  consistence  were  unchanged.  Eeasoning 
from  the  symptoms,  the  lesion  was  very  likely  to  exist.  But  how, 
it  was  argued,  could  a  judgment  be  formed;  we  ought  to  reason 
from  facts,  not  theories?  Here,  then,  was  an  evident  lesion  of  the 
corpus  striatum,  which  explained  nothing,  and  a  problematical 
lesion  of  the  pons  Varolii,  which,  however,  did  it  exist,  would 
satisfactorily  account  for  the  symptoms.  In  this  state  of  un- 
certainty the  microscope  was  sent  for,  and  I  demonstrated,  and 
made  evident  to  Drs.  Paterson,  Peacock,  and  all  the  students 
present,  that  the  corpus  striatum  contained  no  granular  corpuscles, 
whilst  in  the  pons  Varolii  they  were  very  abundant.  I  have  en- 
deavored to  describe  what  took  place  on  this  occasion,  from  which 
it  must  be  evident  that  had  not  the  microscope  been  appealed  to, 
the  right  corpus  striatum  would  have  been  pronounced  softened  ; 
whilst  the  real  lesion  in  the  pons  Varolii  might  have  escaped  ob- 
servation. Under  such  circumstances,  this  case  would  have  added 
another  to  the  inexplicable  observations  with  which  the  records  of 
nervous  diseases  abound."1 

After  such  a  fact,  we  certainly  are  entitled  to  conclude  that  the 
cases,  in  which  it  is  said  that  an  alteration,  only  in  one  side  of  the 
pons,  has  produced  paralysis,  in  both  sides  of  the  body,  cannot 
prove  anything,  because  the  microscope  has  not  shown  that  the 
other  side  of  the  pons  was  not  altered. 

7.  Cases  in  which  an  alteration,  in  one  side  of  the  p>ons  Varolii  or  of 
the  neighboring  parts,  has  produced  paralysis  in  the  same  side  of 
the  hod//. 

I  regret  not  to  have  room  enough  to  treat  at  length  this  subject, 
about  which  much  has  been  said  already  in  Lecture  XII.  I  will 
merely  give  here,  one  only  of  the  cases  that  are  on  record;  then  I 
will  relate,  shortly,  the  different  modes  of  explanation  of  these  facts, 
and,  at  last,  I  will  show  that  these  cases  cannot  be  opposed  to  what 
I  have  said,  as  regards  the  place  of  decussation  of  the  motor  and 
sensitive  nerve-fibres. 

1  Monthly  Jour,  of  Med.  Science.     April,  1S51,  p.  365. 


EXAMINATION    OF    OBJECTIONS.  239 

Case. — Hemiplegia  of  the  left  side,  without  loss  of  sensation  in 
the  arm  and  leg,  but  in  the  left  side  of  the  face  both  sensation  and 
motion  were  entirely  lost.     Loss  of  hearing  in  the  left  ear. 

Autopsy. — A  tumor  was  found  in  the  left  side  of  the  pons  Varolii, 
which  compressed  the  origin  of  the  5th  and  7th  nerves  against  the 
base  of  the  skull.  The  tumor  was  of  the  size  of  a  walnut,  of  a  firm 
consistence,  and  extended  into  the  left  crus  cerebelli.1 

This  case  is  positive,  and  the  co-existence  of  the  paralysis  in  the 
face  and  the  body,  in  the  same  side,  points  out,  at  once,  a  striking 
difference  between  the  ordinary  cases  and  this  extraordinary  one. 
In  the  ordinary  cases,  paralysis  exists  in  the  side  of  the  alteration 
in  the  face,  and  in  the  opposite  side  of  the  trunk  and  limbs. 

I  will  remark  that  in  this  case  there  was  no  paralysis  of  sensi- 
bility in  the  limbs,  and  I  will  add  that  it  has  been  so,  in  all  the 
cases,  but  one,  that  I  know,  in  which  paralysis  has  existed  in  the 
same  side  as  the  alteration. 

Now,  how  to  explain  these  facts  ? 

1st.  There  is  an  explanation  to  which  we  are  naturally  led :  it 
is,  that  in  the  men  spoken  of  in  these  cases,  there  was  no  decussation 
at  all  of  the  sensitive  and  voluntary  motor  nerve-fibres.  This 
would  explain,  not  only  the  cases  relative  to  the  pons,  but  also  the 
cases  in  which  alterations  have  existed  in  one  side  of  the  cerebrum, 
of  the  cerebellum,  of  the  corpora  striata,  or  of  the  thalami  optici, 
and  in  which  hemiplegia  has  existed  in  the  same  side. 

Longet2  says  that,  sometimes,  he  has  not  found  any  appearance 
of  decussation  of  the  pyramids,  in  man,  and  I  have  also  made  the 
same  observation  on  animals. 

2d.  It  may  be  imagined  that  the  decussation  of  voluntary  motor 
and  sensitive  nerve-fibres,  instead  of  taking  place  as  usually,  takes 
place,  in  some  men,  only  in  front  of  the  pons,  between  the  corpora 
quadrigemina  and  the  crura  cerebri. 

3d.  It  may  be,  as  it  results  from  what  we  have  related  above, 
and  what  has  been  found  by  Prof.  H.  Bennett,  that  the  true  altera- 
tion which  really  produces  the  paralysis,  and  which  can  be  detected 
only  with  the  microscope,  is  in  the  side  of  the  encephalon,  opposite 
to  the  side  where  an  alteration  is  seen,  with  the  naked  eye. 

Now,  I  ought  to  say  that,  a  few  years  ago  (in  1855),  by  examining 
the  circumstances  of  the  cases  in  which  there  has  been  only  a  par- 

1  Stanley  in  Lond.  Med.  Gazette.  Vol.  i. 

2  Anat.  et  Physiol,  du  Syst.  Nerv.  Vol.  i.  p.  383. 


240  APPENDIX. 

alysis  of  movement,  I  was  led  to  think  that  there  was  no  decussa- 
tion of  the  pyramids,  and  that  the  decussation  of  the  voluntary 
motor  fibres  either  did  not  exist  at  all,  in  these  cases,  or  existed 
above  the  pons.  As  to  the  case  in  which  there  was  together  a 
paralysis  of  movement  and  of  sensibility,  I  thought  it  might  be  ex- 
plained by  what  results  from  Prof.  Bennett's  researches.  But  now, 
as  it  may  be  seen  in  Lecture  XII.,  and  with  more  details  in  the 
Journal  de  la  Physiologie,  Nos.  3  and  4,  July  and  Oct.,  1858,  I 
have  some  other  views  concerning  those  cases.  I  shall  not  expose 
those  views  again  here,  as  my  object  is  now  only  to  be  able  to  state 
that  those  extraordinary  cases  may  be  explained. 

Both  the  theories  actually  proposed  about  the  place  where  exists 
the  decussation  of  the  voluntary  motor  and  of  the  sensitive  nerve- 
fibres,  one  which  is  the  theory  of  Longet,  Foville,  Valentin  and 
others,  and  the  second  which  is  mine — are,  as  much,  in  apparent 
opposition  with  these  cases  (of  paralysis  in  the  same  side  where  is 
the  alteration),  one  than  the  other.  If  it  were  true,  as  admitted  by 
Foville,  Valentin,  Longet,  etc.,  that  the  decussation  of  the  voluntary 
motor  and  sensitive  nerve-fibres,  takes  place  partly  in  the  pons 
and  partly  behind  and  before  this  organ,  a  considerable  alteration 
of  its  sides,  producing  paralysis,  should  produce  it,  in  both  sides  of 
the  body ;  so  that,  if  paralysis  exists,  only  in  one  side,  be  it  the 
side  of  the  alteration  or  the  other,  the  fact,  in  both  cases,  appears 
as  much  in  opposition  with  the  theory. 

But  we  repeat  that  there  is  now  an  apparently  well-grounded 
explanation  of  the  cases  of  paralysis  in  the  side  altered  in  the  ence- 
phalon,  and  we  refer  to  the  above  quoted  lecture  and  journal  for 
the  details  on  this  subject. 

8.  Cases  and  experiments  which  appear  to  prove  that  there  are,  in  vari- 
ous parts  of  the  encephalon  and  in  the  sp>inal  cord,  motor  nerve-fibres, 
which  are  not  voluntary  motor. 

As  to  the  spinal  cord,  the  existence,  in  it,  of  fibres,  which  are 
motor  but  not  voluntary  motor,  has  alread}^  been  pointed  out  by 
some  physiologists.  As  it  is  not  necessary  for  my  object  here  to 
demonstrate  the  fact,  I  will  merely  state  that  I  believe  it  is  certainly 
true  that  there  are  such  fibres.  As  to  the  encephalon,  not  only  the 
doctrine  of  the  existence  of  such  fibres  is  a  new  one,  but  the  proofs 
themselves,  upon  which  it  is  grounded,  are  mostly  new  or  presented 
here  in  a  new  light. 


EXAMINATION    OF    OBJECTIONS.  241 

For  a  long  while  since  Hippocrates,  it  was  admitted  that  in 
wounds  in  the  brain,  the  convulsions  were  always  in  the  injured 
side,  while  paralysis  was  in  the  opposite  side.  Haller,  though 
inclined  to  admit  this  doctrine,  had  remained  in  doubt  about  it. 

Flourens1  thought  he  had  decided  the  question,  and  he  gave  the 
following  conclusions : — 

1st.  The  cerebral  lobes  and  the  cerebellum  never  give  convul- 
sions. 

2d.  The  quadrigeminal  tubercles  give  convulsions  in  the  opposite 
side. 

3d.  The  medulla  oblongata  and  spinal  cord  give  convulsions  in 
the  injured  side. 

Flourens  has  been  led  to  erroneous  conclusions,  partly  because 
he  has  not  taken  notice  of  what  has  been  observed  in  man,  partly 
because  he  has  particularly  experimented  on  birds. 

Burdach,  according  to  J.  Mueller,2  has  given  the  following  statis- 
tics :  Out  of  268  cases  of  alteration  on  one  side  of  the  encephalon, 
there  have  been  10  cases  of  paralysis  in  both  sides  of  the  bod}',  ancl 
258  of  hemiplegia,  of  which  15  were  in  the  side  of  the  alteration. 
Convulsions  took  place  in  25  cases  in  the  side  of  the  alteration,  and 
in  only  3  cases  in  the  opposite  side. 

From  many  facts  recorded  by  Andral,  Eochoux,  Eostan,  Aber- 
crombie,  Serres,  Bright,  Bouillaud,  Lallemand,  and  Eomberg,  it 
results  that  convulsions  in  the  side  of  the  alteration  appear  to  be 
less  frequent  than  convulsions  in  the  opposite  side.  So  that  the 
results  arrived  at  by  Burdach  are  opposed  to  the  results  of  these 
more  recent  writers.  But  whatever  may  be  about  this,  it  is  suffi- 
cient, for  my  object  now,  that  it  is  certain  that  convulsions  may 
take  place,  either  in  the  side  where  is  the  alteration  or  injury  of 
the  encephalon,  or  in  the  opposite  side. 

Now,  there  are  other  and  very  curious  facts  which  also  prove 
that  contractions  of  certain  muscles  of  the  body  may  take  place 
either  in  the  side  of  the  body  corresponding  to  the  injured  side  of 
the  encephalon,  or  in  the  opposite  side,  exactly  as  in  the  cases  of 
ordinary  convulsions,  as  I  have  just  said.  And,  in  fact,  this  might 
have  been  foreseen,  had  it  been  known  that  a  convulsive  state  of 
certain  muscles  is  the  cause  of  the  phenomena  of  which  I  will  now 
say  a  few  words. 

1  Loco  cit.,  p.  120. 

2  Manuel  de  Physiol.     Ed.  Littre,  1851,  vol.  i.  p.  783. 

Q 


242  APPENDIX. 

If  a  puncture  or  rather  a  slight  section  is  made,  on  mammals,  in 
different  parts  of  the  encephalon,  we  see  quite  different  effects, 
according  to  the  part  which  has  been  injured.  The  animal  turns 
round  or  rolls  over  itself  (see  my  paper  on  Taming  and  Rolling  in 
Exp.  Researches,  p.  18,  and  Lecture  XL),  and  this,  as  I  will  prove 
elsewhere,  in  consequence  mostly  of  local  convulsions.  Turning 
or  rolling  takes  place  after  an  injury  of  the  right  side,  sometimes 
on  the  right,  sometimes  on  the  left  side  of  the  body,  as  I  have 
already  shown. 

In  almost  all  these  experiments,  turning  or  rolling  exists  on  the 
side  where  there  are  convulsions  in  certain  muscles.  The  spasms 
exist  in  all  cases,  in  the  muscles  of  the  neck,  frequently  in  those 
of  the  trunk,  and  sometimes  in  those  of  the  limbs.  The  convul- 
sions of  the  muscles  of  the  neck  and  trunk  are  sufficient,  without 
the  assistance  of  the  limbs  to  produce  rolling,  as  I  have  frequently 
seen,  after  the  amputation  of  the  four  limbs. 

It  seems  quite  certain  from  these  two  series  of  facts  (i.  e.,  pure 
convulsions  in  one  side  of  the  body  and  the  local  spasms  coexist- 
ing with  turning  and  rolling),  that  convulsions  may  be  produced 
in  muscles  of  one  side  of  the  body,  by  the  same  alteration  which 
produces  paralysis  in  the  opposite  side.  From  this  it  results  that 
there  are  two  different  sets  of  motor  nerve-fibres,  which  appear  to 
originate  from  the  same  place,  in  many  parts  of  the  encephalon, 
one  set  being  composed  of  voluntary  motor-fibres,  which  then 
become  paralyzed,  and  the  other  set  composed  of  motor  fibres, 
which  are  not  voluntary  motor,  because,  were  they  so,  their  altera- 
tion would  produce  paralysis,  and  we  should,  therefore,  have  then 
a  paralysis  in  both  sides  of  the  body,  although  the  alteration  should 
exist  only  in  one  side  of  the  brain.  But  what  are  these  fibres,  as 
they  cannot  be  voluntary  motor?1  They  certainly  are  able  to  pro- 
duce muscular  contractions,  and,  therefore,  we  are  entitled  to  call 
them  motor,  but  we  do  not  know  whether  the  irritation  acts  directly 

1  It  is  well  known  that  no  movement  is  produced  in  the  limhs  and  trunk,  when 
an  excitation  of  any  kind  is  hrought  upon  the  cerebral  lobes  or  even  the  corpora 
striata.  As  the  voluntary  motor  fibres  extend  into  the  encephalon,  if  not  into  the 
cerebral  lobes,  at  least  into  the  corpora  striata,  it  is  certain  that  there  these  fibres 
cannot  be  irritated  by  our  means  of  excitation.  It  may  be  that  these  fibres 
remain  so,  unirr italic  all  along,  from  these  parts  of  the  encephalon  to  their  termi- 
nation in  muscles,  and  that  the  nerve-fibres  which  produce  contractions  when  we 
irritate  them,  either  in  the  encephalon,  in  the  spinal  cord,  or  in  the  nerves,  belong 
to  the  other  class  of  motor  nerves,  the  existence  of  which  I  am  now  trying  to 
establish. 


EXAMINATION    OF    OBJECTIONS.  243 

upon  them,  or  whether  it  is  by  a  secondary,  that  is  a  reflex  action 
that  they  become  excited.  It  may  be,  and  this  seems  very  proba- 
ble, that  they  are  merely  reflecto-motor. 

But,  whatever  is  the  truth  about  their  nature,  they  are  motor, 
and  they  exist  in  great  number,  in  all  the  isthmus  of  the  ence- 
phalon,  and  particularly  in  the  medulla  oblongata.  We  can  by 
this  fact  understand  why  there  are  so  many  motor  fibres  belonging 
to  the  anterior  columns  of  the  spinal  cord  which  are  not  voluntary 
motor. 

9.  Anatomico-pathological  dissections  which  appear  to  prove  that  there 
are  nerve- fibres,  coming  from  the  spinal  cord,  which  decussate  in  parts 
above  the  medulla  oblongata. 

The  interesting  facts  discovered  by  Dr.  Luclwig  Tiirck,  of  Vienna,1 
showing  that  when  there  is  an  alteration  of  a  part  of  the  ence- 
phalon,  the  nerve-fibres  which  go  from  that  part  into  and  along 
the  spinal  cord,  become  very  much  altered  in  their  structure,  have 
proved  that  there  is  a  decussation  for  these  fibres  in  the  Pons 
Varolii  or  in  parts  before  it.2  I  do  not  think  necessary  to  dis- 
cuss at  length  the  value  of  these  researches,  in  relation  to  the 
subject  of  this  paper.  I  believe  it  is  sufficient  to  say  that,  as  long- 
as  there  are  other  fibres,  besides  the  sensitive  and  the  voluntary 
motor,  which  originate  from  the  different  parts  of  the  encephalon, 
nothing  in  the  curious  facts  described  by  Dr.  Tiirck  would  prove 
against  our  admitting,  that  the  decussation  of  the  sensitive  and 
voluntary  motor  fibres  takes  place  where  I  have  tried  to  show  that 
it  does. 

This  means  of  study  of  Dr.  Tiirck  will  have  the  greatest  value 
when  (and  only  when)  it  shall  be  combined  with  all  the  other  means 
that  science  already  possesses  to  determine  what  are  the  kinds  of 

1  See  Braithwaite's  Retrospect,  Amer.  edit.,  part  xxvii.  p.  344. 

2  Dr.  Tiirck  is  disposed  to  consider  the  alteration  produced,  in  these  cases,  in 
nerve-tubes,  as  a  result  of  absence  of  action.  I  believe  this  view  is  partly  right, 
but  there  is  another  cause  of  alteration,  which  is — according  to  what  I  have  tried 
to  show  in  a  paper  presented  more  than  five  years  ago,  to  the  Society  de  Biologie — 
that  the  nerve-tubes  are  endowed  with  capillarity,  and  that  liquids,  in  which  is 
placed  a  divided  end  of  them,  are  absorbed,  and  conveyed  very  far  in  their  canal, 
and  there  altering  their  contents.  The  spinal  cord  may  become  secondarily 
affected,  in  that  way,  by  diseases  of  the  different  viscera,  and  this  may  prove  to  be 
a  good  means  of  finding  the  course  of  the  roots  of  the  nerves  in  the  spinal  cord. 
I  had  already  made  some  researches  about  the  disposition  of  these  roots  five  years 
ago,  and  I  intend  to  resume  them  as  soon  as  possible. 


244:  APPENDIX. 

nerve-fibres  existing  in  the  nervous  centres,  and  what  is  their  re- 
spective course. 

General  Conclusions. — In  the  first  part  of  this  appendix  I  have 
tried  to  prove  successively  : — 

a.  That  reflex  movements  alone,  and  not  sensations  and  volitions, 
exist  in  monsters,  deprived  of  a  great  part  of  their  cerebro-spinal 
axis. 

b.  That  when  the  spinal  cord,  the  medulla  oblongata,  or  the 
Pons  Varolii  are  altered,  even  considerably,  sensibility  and  voli- 
tion may  continue  to  exist,  because  there  are  still  communications 
by  nerve-fibres  through  the  altered  part,  between  the  nerves  of  the 
trunk  and  limbs,  and  the  parts  of  the  encephalon,  in  front  of  the 
Pons. 

c.  That  if  the  reasons  given  by  many  physiologists  to  prove  that 
the  Pons  Varolii  is  the  seat  of  the  centre  for  volition  and  for  per- 
ception of  sensitive  impressions  were  true,  we  should  have  to  admit 
that  the  medulla  oblongata  is  the  centre  (or,  at  least,  a  part  of  the 
centre)  for  these  faculties,  because  the  same  reasons  appear  to  prove 
the  same  for  this  organ  as  for  the  Pons. 

d.  That  very  likely  these  faculties  have  not  their  centre  (at  least 
their  principal  centre)  in  the  Pons  Varolii,  and,  still  less,  in  the 
medulla  oblongata. 

e.  That  there  appears  to  be,  in  many  places  of  the  encephalon, 
nerve-fibres,  which  are  not  voluntary  motor,  and  which,  neverthe- 
less, go  to  muscles,  either  in  the  same  side  of  the  body  as  the  side 
of  the  encephalon,  from  which  they  originate,  or  in  the  opposite 
side,  and  that  these  muscular  nerve-fibres  are  able  to  produce  con- 
vulsions when  they  are  irritated  by  an  injury  or  an  alteration  in 
the  encephalon,  so  that  convulsions  may  take  place  either  in  the 
paralyzed  side  or  in  the  other. 

/.  The  results  of  the  researches  of  Dr.  Ludwig  Tiirck  cannot,  in 
the  actual  state  of  science,  prove  against  or  in  favor  of  any  doctrine 
relative  to  the  place  of  decussation  of  sensitive  and  voluntary 
motor  nerve-fibres. 


PART  II.  APPLICATION  OF  SOME  OF  THE  FACTS  AND  VIEWS,  EXPOSED 
IN  THE  PRECEDING  LECTURES,  TO  THE  TREATMENT  OF  DISEASE. 

I  will  give  here  a  short'  summary  of  several  of  the  principal  de- 
ductions for  the  practice  of  the  various  branches  of  medical  science, 
that  may  be  drawn  from  many  of  the  facts  and  views  presented  in 


APPLICATION    OF    FOREGOING-    VIEWS    TO    SURGERY.      2-45 

my  lectures.  I  shall  divide  this  second  part  of  this  appendix  into 
several  chapters,  which  will  contain :  1st,  application  to  surgery ; 
2d,  application  to  medicine;  3d,  application  to  obstetrics. 

Chap.  I.  Application  to  /Surgery.— The  first  object  to  which  I 
shall  call  the  attention  of  my  readers,  concerns  the  treatment  of  frac- 
tured spine,  and  the  first  question  I  shall  examine  on  this  subject,  is 
whether  it  may  or  not  be  useful  to  employ  the  trephine,  with 
the  view  of  removing  a  broken  part  of  the  bony  ring  of  the  ver- 
tebrae. I  am  convinced  that  the  life  of  some  patients  might  be 
saved  by  this  means,  and  I  hope  the  following  discussion  will  give 
the  same  faith  to  others.  I  shall  try  to  prove :  1st,  that  the  laying 
bare  of  the  spinal  cord  is  not  a  dangerous  operation  ;  2d,  that  death, 
after  a  fracture  of  the  spine,  is  usually  due  to  the  effects  of  a  pres- 
sure, or  an  excitation  upon  the  spinal  cord,  and  not  the  result  of 
a  partial  or  a  complete  section  of  this  organ ;  3d,  that  reunion  may 
take  place  after  a  wound  of  the  spinal  cord,  so  that  its  lost  func- 
tions may  return ;  4th,  that  the  removal  of  some  parts  of  the  ver- 
tebras may  be  followed  by  a  production  of  new  bone  ;  5th,  that  the 
cases  of  fracture  of  the  spine  in  which  the  trephine  has  been  applied 
show  the  usefulness  of  this  operation. 

1st.  The  exposition  of  the  spinal  cord  to  the  action  of  the  atmosphere 
is  not  a  dangerous  operation. — One  of  the  principal  objections  raised 
against  the  use  of  the  trephine,  in  cases  of  fractured  spine,  is  that 
the  laying  bare  of  the  spinal  cord  is  a  dangerous  thing.  This  quite 
erroneous  opinion  has  no  other  foundation,  that  I  am  aware  of, 
than  the  well  known  fact  that  the  laying  bare  of  the  brain  or  of 
its  meninges  is  dangerous,  and  that  in  cases  of  tapping,  for  spina 
bifida,  a  meningitis  is  sometimes  produced  by  the  supposed  irrita- 
tion of  atmospheric  air  upon  the  spinal  meninges.  But,  as  regards 
the  first  one  of  these  grounds  for  an  opinion  that  I  consider  entirely 
erroneous,  it  is  sufficient  to  say,  that  it  is  only  an  inferential  reason 
and  not  a  direct  proof,  and  as  regards  the  second,  I  will  say  that 
certainly  it  is  not  the  laying  bare  of  the  spinal  cord,  or  its  mem- 
branes, which  causes  a  meningitis  after  tapping,  in  cases  of  spina 
bifida,  as  this  inflammation  occurs  as  frequently  after  the  perform- 
ance of  the  operation  by  the  subcutaneous  method,  as  after  the  use 
of  the  old  method.  We  may  add  that  the  meninges  of  the  spinal 
cord,  in  ordinary  circumstances,  do  not  become  inflamed  so  easily 
as  in  cases  of  spina  bifida,  and  that  the  meninges  of  the  brain 
are  much  more  liable  to  become  inflamed  than  those  of  the  spinal 


246  APPENDIX. 

cord,  as  is  proved  by  the  relatively  small  number  of  cases  of 
inflammation  of  the  spinal  meninges  after  they  have  been  injured 
by  a  piece  of  bone,  a  sword,  etc. 

The  opening  of  the  spinal  canal  and  the  laying  bare  of  the 
spinal  meninges,  or  of  the  cord  itself,  are  not  dangerous  operations 
in  animals.  I  may  safely  say,  that  one  dog,  cat,  or  guinea-pig,  out 
of  ten,  hardly  dies  from  having  the  spinal  cord  laid  bare,  in  the 
extent  of  an  inch  or  even  more.  Of  course,  these  facts  cannot 
prove  that  in  man  the  same  innocuity  would  exist,  as  we  know 
that  certain  membranes  and  organs  are  much  more  easily  inflamed 
in  man  than  in  animals.  But  there  are  facts,  of  which  I  will  speak 
hereafter  (especially  the  similarity  of  results  of  fractures  of  the  spine 
in  men  and  in  the  animals  already  mentioned),  which  seem  to  show 
that  there  is  no  great  difference  between  these  animals  and  men,  as 
regards  the  power  of  inflammation  of  the  spinal  cord,  or  its  mem- 
branes ;  so  that  it  is  at  least  very  probable,  that  what  is  found  in 
the  above  experiments  on  dogs,  cats,  etc.,  would  also  be  observed 
in  man. 

One  of  the  most  decisive  reasons,  however,  for  our  admitting 
the  truth  of  the  proposition,  that  there  is  no  danger  in  the  laying 
bare  the  spinal  cord  in  man,  consists  in  the  existence  of  several 
cases  like  the  following  in  which  there  has  been  no  ill  effect  at  all, 
caused  by  the  exposition  of  this  organ  to  the  contact  of  the  atmo- 
sphere. 

In  a  curious  case  of  syphilitic  caries  of  the  spine,  A.  Mercogliana, 
an  Italian  surgeon,  removed  (through  a  deep  ulcer  of  the  throat) 
the  body  of  the  third  cervical  vertebra,  leaving  the  spinal  cord 
bare.  The  patient  had  no  trouble  whatever  in  the  functions  of  this 
nervous  centre,  and  recovered.  [Gazette  Medicate  de  Paris,  1832,  pp. 
589-90.) 

In  another  case,  analogous  to  the  preceding,  a  part  of  a  cervical 
vertebra  was  removed  by  another  Italian  surgeon,  Marcacci.  The 
patient  was  quickly  cured.  (Gazette  Medicate  de  Paris,  1850,  p.  268.) 

In  a  case  of  acephalocystic  cyst,  in  the  spinal  canal,  the  bones 
became  altered,  and  the  cyst  having  been  opened,  the  spinal  cord 
was  laid  bare.  No  ill  effect  is  mentioned  as  the  result  of  this 
operation.  (Traite  des  Maladies  de  la  Moelte  qnn.,  par  Ollivier 
d?Angers,  1837,  vol.  ii.  p.  547.) 

Three  cases  of  exfoliation  of  the  atlas,  one  observed  by  Mr. 
Robert  Wade,  the  two  others  by  Mr.  Prescott  Hewett,  were  com- 
municated to  the  Royal  Medico-Chirurgical  Society  of  London  in 


APPLICATION    OF    FOREGOING    VIEWS    TO    SURGERY.      247 

February,  1849.  The  three  patients  got  well.  {London  Journal  of 
Medicine,  April,  1849,  p.  395.) 

From  these  facts,  and  from  several  similar  ones  which  have  been 
published  in  various  medical  journals,  it  seems  that  we  are  entitled 
to  draw  the  conclusion  that  the  action  of  the  air  upon  the  spinal 
cord  is  not  a  dangerous  one. 

But  it  is  still  more  important  to  state  that  there  are  no  cases  on 
record,  so  far  as  we  know,  of  removal  of  broken  parts  of  the  spine, 
in  which  the  operation  has  been  followed  by  a  meningitis.  This 
assertion  will  be  proved  hereafter,  when  we  give  the  principal 
details  of  all  the  cases  we  know  of  application  of  the  trephine  to 
the  spine.  In  animals  I  never  saw  meningitis  produced  by  injuries 
to  the  three  membranes  that  surround  the  spinal  cord. 

It  seems  certain,  from  the  facts  above  mentioned,  that  the  laying 
bare  of  the  spinal  meninges,  or  even  of  the  spinal  cord  after  the 
section  of  the  meninges,  cannot  be  considered  as  dangerous  opera- 
tions either  in  man  or  in  animals. 

2d.  Death  after  a  fracture  of  the  spine  is  usually  due  to  the  effects 
of  a  pressure  or  some  excitation  upon  the  spinal  cord,  and  not  to  the 
results  of  a  partial  or  a  complete  section  of  this  organ. — It  would  be 
out  of  place  here  to  enter  fully  into  the  demonstration  of  this  pro- 
position. TVe  will  only  give  a  short  account  of  the  various  causes 
of  death  after  a  fracture  of  the  spine,  which  will  sufficiently  show 
what  share  a  pressure  or  a  mechanical  excitation  of  the  spinal  cord 
has  among  these  causes. 

When  the  spine  is  fractured  high  up  in  the  cervical  region,  if 
the  spinal  cord  is  crushed,  death  occurs  instantaneously  or  after 
a  very  short  time,  on  account,  partly,  of  the  cessation  of  respiration, 
and  also,  partly,  of  a  peculiar  influence  on  the  heart  similar  to  that 
influence  exerted  by  the  par  vagum  when  it  is  galvanized  by  a 
powerful  and  interrupted  galvanic  current.1  But  when  the  fracture 
is  in  the  lower  part  of  the  cervical  region,  or  in  the  upper  part  of 
the  dorsal  region,  the  effects  it  produces  are  usually  quite  different. 
If  the  cord  is  partially  crushed  or  incised,  and  if  there  is  no  pres- 
sure upon  it,  the  patient's  life  may  be  saved.  It  is  only  when  this 
nervous  centre  is  completely  or  almost  completely  severed,  that 
death  seems  to  be  unavoidable.     But  if  there  is  pressure  only,  as 

1  For  the  influence  of  the  medulla  oblongata  and  spinal  cord  on  the  heart,  see 
my  paper  in  Journal  de  la  Physiologie,  vol.  iii.  1860,  p.  152. 


248  APPENDIX. 

is  usually  the  case,  life  may  be  saved ;  and  it  is  in  such  cases  that 
the  application  of  the  trephine  might  be  very  useful. 

When  the  fracture  is  in  the  middle  of  the  dorsal  region,  there  is 
a  chance  for  the  patient  to  have  his  life  saved,  even  if  the  cord  is 
completely  severed ;  and,  of  course,  the  chance  is  still  greater  if 
only  a  part  of  the  thickness  of  this  organ  is  divided  or  crushed. 
If  there  be  only  pressure,  we  think  there  is  a  great  probability  of 
cure  by  the  removal  of  this  mechanical  excitation. 

The  influence  of  a  mechanical  excitation  of  the  spinal  cord  by  a 
broken  piece  of  bone  deserves  the  full  attention  of  both  the  phy- 
siologist and  the  practitioner.  Among  the  alterations  in  the  nutri- 
tion of  the  paralyzed  parts  in  cases  of  that  kind  we  will  particularly 
notice  the  sloughs  on  the  sacrum,  and  the  various  morbid  changes 
that  take  place  in  the  bladder  and  in  the  urinary  secretion.  These 
alterations  in  nutrition  and  secretion  are  certainly  frequent  causes 
of  death  after  fractures  of  the  spine.  Therefore,  it  is  of  the  greatest 
importance  to  find  out  the  mode  of  production  of  these  morbid 
changes,  and  to  try  to  prevent  or  to  cure  them. 

The  production  of  sloughs  on  the  sacrum  cannot  be  considered 
as  an  effect  of  prolonged  pressure  of  the  trunk  upon  the  parts  of 
the  skin  where  they  appear,  as  they  sometimes  are  produced  in  a 
few  days  and  even  in  a  few  hours  after  the  fracture.  They  result 
from  a  morbid  excitation  of  the  spinal  cord,  and  not  from  the  loss  of 
action  of  that  nervous  centre  owing  to  its  partial  or  complete  section, 
as  proved  by  experiments  showing  that  they  never  occur  after  sec- 
tion of  the  cord.  The  proof  that  pressure  upon  the  sacrum  has 
but  a  slight  influence  on  their  production  is  clearly  given  in  the 
case  of  animals  on  which,  after  a  fracture  of  the  spine,  I  have  seen 
sloughs  occurring  in  parts  that  were  not  submitted  to  pressure. 
Besides,  it  is  known  that  men  who  are  confined  to  bed  by  other 
causes  than  a  nervous  complaint,  may  bear  pressure  upon  some 
part  of  the  body  for  a  long  while  without  the  production  of  sloughs. 
Pressure  on  the  sacrum  is,  therefore,  only  an  additional  cause  of 
sloughs.  For  the  mode  of  action  of  the  nervous  system  in  pro- 
ducing alterations  of  nutrition,  I  will  refer  to  my  lecture  on  the 
influence  of  the  nervous  system  upon  nutrition,1  and  I  will  only 

1  Lecture  X.  pp.  151-177.  For  more  details  on  the  capital  point  that  it  is 
chiefly  owing  to  a  morbid  action  of  the  nervous  system  that  alterations  of  nutrition 
take  place  in  diseases  of  that  system,  and  not,  as  generally  supposed,  to  a  para- 
lysis, i.  e.,  to  the  cessation  of  action  of  that  system,  see  Journal  de  Physiologie, 
1859,  p.  112. 


APPLICATION"    OF    FOREGOING    VIEWS    TO    SURGERY.      249 

say  here  that  an  irritation  and  not  a  paralysis  is  the  cause  of  these 
morbid  changes. 

It  is  an  important  fact  that,  after  fractures  of  the  spine  in  the 
dorsal  or  lumbar  regions,  it  is  very  frequent  that  sloughs  cause 
death  by  the  propagation  of  the  inflammation  of  the  fibrous  tissue 
lining  the  sacrum,  to  the  membranes  of  the  spinal  cord,  producing 
a  very  acute  and  quickly  fatal  meningitis.  As  a  pressure  upon 
the  spinal  cord  by  a  fractured  bone  may  produce  sloughs  and  a 
fatal  meningitis,  it  is  important  to  try  to  remove  such  a  mechani- 
cal excitation  of  the  cord.  We  must  say,  however,  that  after  the 
removal  of  the  broken  pieces  of  bone,  the  danger  of  the  production 
of  sloughs,  though  much  diminished,  would  not  be  altogether  re- 
moved, as  a  cause  of  them  may  remain,  i.  e.,  a  myelitis. 

Another  morbid  change  due  to  a  mechanical  excitation  of  the 
spinal  cord  may  also  cause  death  after  a  fracture  of  the  spine ;  it  is 
the  alteration  which  takes  place  in  the  kidneys,  an  alteration  some- 
times amounting  to  a  real  inflammation.  We  hardly  need  to  say 
that  the  changes  in  the  urinary  secretion,  owing  or  not  to  an  in- 
flammation of  the  kidneys,  and  also  the  hematuria  or  the  alterations 
in  the  mucous  membrane  of  the  bladder  in  cases  of  fracture  of  the 
spine,  are  morbid  phenomena  depending  upon  an  irritation  of  the 
spinal  cord,  and  not  upon  a  paralysis  due  to  a  division  of  this 
organ.  On  the  one  hand,  a  section  of  the  cord  is  never  followed 
by  these  alterations  in  the  kidney  or  the  bladder;  on  the  other 
hand,  we  often  observe  these  alterations  too  quickly  after  the  spine 
has  been  fractured,  to  admit  that  they  are  due  to  a  paralysis. 

Other  causes  of  death  besides  the  preceding  exist  in  cases  of 
fracture  of  the  spine,  depending  also  upon  a  mechanical  excitation 
of  the  spinal  cord.  I  will  simply  name  the  principal  of  these 
causes ;  they  are,  a  myelitis,  an  increase  in  the  amount  of  the 
cerebro-spinal  fluid,  and  the  influence  upon  the  heart  when  the 
excitation  exists  in  the  cervical  region.  It  is  not  a  section  of  the 
spinal  cord  that  usually  produces  these  causes  of  death ;  it  is  the 
excitation  of  this  nervous  centre  by  broken  pieces  of  bone.  If  we 
divide  or  crush  the  spinal  cord  in  animals,  we  rarely  find  an  in- 
flammation occurring  in  this  organ,  and  the  beatings  of  the  heart, 
instead  of  being  diminished  in  frequency  and  force  as  when  the 
spinal  cord  is  irritated,  increase  in  a  more  or  less  marked  degree. 
It  is,  therefore,  extremely  important  to  remove,  if  possible,  the 
pieces  of  bone  that  irritate  the  spinal  cord,  to  avoid  a  myelitis,  and 
the  other  causes  of  death  above  mentioned. 


250  APPENDIX. 

To  complete  the  demonstration  of  the  proposition  that  death 
after  a  fracture  of  the  spine  is  usually  due  to  the  effects  of  the  ex- 
citation of  the  spinal  cord  by  broken  pieces  of  bone,  and  not  to  the 
results  of  a  partial  or  complete  section  of  this  nervous  centre,  we 
will  only  say  that  there  are  many  cases  on  record  showing  that  a 
section  or  even  a  crushing  of  the  spinal  cord  has  not  proved  fatal, 
and  that  in  animals  death  is  rarely  caused  by  a  partial  or  complete 
section  of  the  cord  in  the  dorsal  region,  while  they  die  as  quickly 
and  as  often  as  men  after  a  fracture  of  the  spine,  if  the  broken 
pieces  are  not  removed. 

3d.  Reunion  may  take  place  after  a  wound  of  the  spinal  cord,  so 
that  its  last  functions  may  return. — My  experiments  upon  animals,1 
and  also  several  pathological  cases  observed  in  man,  prove  the  truth 
of  this  proposition.  I  must  say,  in  addition,  that  I  have  sometimes 
seen  a  notable  return  of  lost  functions  in  animals  the  spine  of 
which  had  been  fractured  and  the  spinal  cord  crushed. 

4th.  The  removal  of  some  parts  of  the  vertebrce  may  be  followed  by 
a  production  of  new  bone. — This  is  a  fact  that  I  have  observed  a  great 
many  times  in  animals,  even  in  cases  when  I  had  taken  away  the 
'posterior  half  of  the  bony  ring  of  five  or  six  vertebras.  Generally 
the  reproduction  of  bone  is  very  slow  except  in  young  animals. 
The  new  bones  are  larger  and  thicker  than  those  taken  away.  I 
never  saw,  but  once,  the  reproduction  of  a  spinous  process.  In 
man,  after  fractures  of  the  spine,  new  pieces  of  bone  have  often  been 
found  round  the  callus,  in  cases  when  life  has  lasted  more  than  one 
or  two  months. 

5th.  The  cases  of  fracture  of  the  spine  in  which  the  trephine  has  been 
applied  show  the  usefulness  of  this  operation. — Before  mentioning 
these  cases  I  must  say  a  few  words  on  the  results  of  my  experi- 
ments upon  animals.  I  have  found  that  if,  after  a  fracture  of  the 
posterior  arch  of  some  vertebras  in  the  dorsal  or  lumbar  region  in 
dogs,  cats,  and  guinea-pigs,  I  removed  the  broken  pieces  of  bone, 
most  of  them  were  quickly  restored  to  health.  Some  of  them,  in 
which  the  spinal  cord  had  been  either  crushed  or  partially  divided, 
remained  more  or  less  paralyzed  either  for  a  long  while  or  per- 
manently. A  few  died  either  of  myelitis  or  some  other  cause. 
These  experiments  clearly  prove  the  importance  of  the  removal  of 
fragments  of  bone  in  certain  kinds  of  fracture  of  the  spine  in 
animal*     No  positive  conclusion,  however,  could  be  drawn  from 

1  Experimental  Researches  applied  to  Physiol,  and  Pathol.,  New  York,  1853,  p.  17. 


APPLICATION    OF    FOKEGOING    VIEWS    TO    SUKGEEY.      251 

these  experiments  alone  as  regards  trephining  in  cases  of  fracture 
of  the  spine  in  man,  as  animals  may  be  quite  different  from  man. 
But,  as  I  have  ascertained  that  dogs,  cats,  and  guinea-pigs  almost 
always  die  after  having  presented  the  same  symptoms  that  are 
observed  in  man,  after  a  fracture  of  the  spine,  when  the  broken 
pieces  of  bone  are  not  removed,  it  is  fair  to  conclude,  from  the 
above  experiments,  that  trephining  might  be  a  useful  operation  in 
man  as  it  is  in  animals. 

The  first  case  of  trephining  of  the  spine  in  man,  in  which  the 
operation  was  successful,  is  related  by  Louis,  the  most  celebrated 
French  surgeon  of  the  eighteenth  century.  A  man  received  a  gun- 
shot in  the  dorsal  region  of  the  spine,  in  consequence  of  which  he 
became  completely  paralyzed  in  the  lower  limbs ;  the  wound  was 
enlarged  at  once,  and  the  ball  taken  out.  Louis  saw  the  patient 
on  the  fourth  day  after  the  injury;  he  found  that  there  were  several 
fragments  of  bone  pressing  upon  the  spinal  cord.  He  removed 
these  fragments,  and,  although  there  was  a  considerable  suppuration 
after  this  operation,  the  paraplegia  slowly  but  gradually  disappeared, 
and  the  patient  was  completely  cured,  excepting,  however,  a  slight 
weakness  which  remained  in  his  lower  limbs.1 

In  the  above  case  we  have  a  proof  that  the  removal  of  broken 
pieces  of  bone  may  be  quite  successful,  at  least  when  the  fracture 
of  the  spine  is  due  to  gunshot,  and  limited  to  the  posterior  arch  of 
a  vertebra. 

Another  important  case  of  cure  of  fracture  of  the  spine,  obtained 
by  surgical  interference,  is  mentioned  in  the  following  terms  in  the 
British  and  Foreign  Medical  Review,  for  1838,  p.  162:  "We  know 
only  four  cases,  and  of  these  one  was  performed  successfully,  as  we 
are  informed,  only  a  few  months  ago,  by  a  surgeon  of  the  name  of 
Edwards,  living  at  Caerphilly,  in  South  Wales.  There  were  present 
the  usual  symptoms  of  compression,  paralysis  of  the  organs  of 
locomotion,  the  rectum,  and  the  bladder.  The  situation  (of  the 
fracture),  as  far  as  the  operation  was  concerned,  was  unfavorable — 
the  lumbar  region.  The  posterior  arch  of  the  bone  was  raised,  the 
symptoms  of  compression  relieved,  and  the  patient  did  well."  It 
is  a  pity  that  the  details  of  this  fact  have  not  been  published. 
However,  we  have  there  a  clear  proof  that  the  most  happy  result 
may  be  obtained  by  the  elevation  of  a  depressed  bone  in  a  case  of 
fracture  of  the  spine. 

1  Memoire  posthume,  in  Archives  Gen.  de  Medecine,  etc.,  Aout,  1836,  p.  397. 


252  APPENDIX. 

A  third  successful  case  of  surgical  operation  on  the  spine  after  a 
fracture,  has  been  published  by  Dr.  Alban  W.  Smith,  of  Kentucky. 
{North  Amer.  Med.  and  Surg.  Journal,  July,  1829,  p.  9-i.)  Two 
years  after  a  fall  that  was  followed  by  complete  paralysis  of  the 
four  limbs,  except  the  muscles  above  the  elbow  on  each  side,  it  was 
supposed  that  there  was  a  fracture  of  the  base  of  the  spinous  process, 
and  that  there  was  compression  of  the  spinal  cord  by  the  broken 
piece  of  bone.  "The  diagnosis,"  says  Dr.  Smith,  "was  confirmed 
by  the  operation."  The  fragments  were  found  displaced  laterally, 
but  so  completely  fused  and  offering  so  smooth  a  surface  that  the 
line  of  separation  was  not  well  marked.  With  a  Hey's  saw  the 
operator  divided  first  each  side  of  the  second  dorsal  vertebra,  as 
near  as  possible  to  the  bases  of  the  transverse  processes ;  and  re- 
sected and  raised  up  a  portion  of  the  spinous  processes  of  two 
vertebras,  half  that  of  the  third  and  all  that  of  the  fourth,  which 
seemed  most  deeply  driven  in.  No  lad  symptoms  ensued ;  sensibility 
was  regained  in  the  thighs  and  in  the  hands,  auguring  well  for  the 
re-establishment  of  motion. 

It  is  much  to  be  regretted  that  the  further  history  of  this  case 
has  not  been  published ;  but,  so  far  as  it  goes,  it  proves,  like  the 
two  preceding  cases,  that  in  man  as  in  animals,  the  exposition  of 
the  spinal  meninges  to  the  atmospheric  air  is  not  a  dangerous 
operation  ;  it  shows  also  that  good  results  may  be  quickly  obtained 
by  the  removal  of  a  bone  compressing  the  spinal  cord.  The  account 
published  by  Dr.  Alban  "W.  Smith  has  been  severely  criticized  by 
several  writers.  We  agree  with  Malgaigne1  when  he  says  that 
the  diagnosis  was  made  out  carelessly,  and  the  operation  rashly 
undertaken;  but  he  certainly  is  unjust  when  he  says  that  "all  the 
dates  are  omitted,  and  the  seat  of  the  lesion  not  stated."  True,  the 
dates  are  omitted,  but  it  is  said  that  it  was  two  years  after  the  frac- 
ture that  the  operation  was  made ;  and,  as  regards  the  seat  of  the 
lesion,  the  second,  third,  and  fourth  dorsal  are  clearly  designated. 

If  we  now  study  those  cases  of  trephining  applied  to  the  spine, 
in  which  the  operation  has  not  saved  the  life  of  the  patients,  we 
find,  in  the  first  place,  that  the  operation  has  not  proved  injurious, 
and,  in  the  second  place,  that  it  has  been  often  followed  by  an  ame- 
lioration in  the  condition  of  the  patient.  We  also  find  that  those 
cases  were  all  very  bad  ones,  and  that  death  was  to  be  expected  in 

1  See  the  excellent  translation  published  by  Dr.  J.  H.  Packard,  of  Philadelphia, 
of  Malgaigne's  Treatise  on  Fractures,  Philad.,  1859,  p.  336. 


APPLICATION    OF    FOREGOING    VIEWS    TO    SURGERY.      253 

all.  Still  more,  in  some  cases  besides  the  fracture  of  the  spine, 
there  were  other  injuries  sufficient  to  cause  death.  We  will  men- 
tion some  of  the  most  interesting  of  those  cases,  and  also  those  the 
authenticity  of  which  is  most  certain. 

In  1822,  a  patient  with  a  fracture  of  the  ninth  and  tenth  dorsal 
vertebras  was  admitted  at  St.  Thomas's  Hospital.  There  was  a 
complete  paraplegia  of  the  lower  limbs,  the  bladder,  and  the  rectum. 
The  posterior  arch  of  the  two  broken  vertebrae  was  removed,  so 
that  three  inches  of  the  spinal  meninges  were  laid  bare.  A  few 
hours  after  the  operation,  the  patient  felt  when  he  was  pinched, 
which  had  not  been  the  case  previously ;  he  recovered  at  least 
partly  the  voluntary  power  over  the  lower  limbs,  the  bladder,  and 
the  rectum.  However,  the  patient  died  a  fortnight  after  the  opera- 
tion, but  from  a  peritonitis  and  an  enteritis,  which  seem  to  have 
been  produced  by  the  cause  of  the  fracture.1 

Mr.  J.  F.  South,  in  one  of  the  important  notes  he  has  added  to 
his  excellent  translation  of  Chelius,2  says  of  the  above  case :  "  The 
result  of  Tyrrell's  case,  which  was  certainly  most  favorable  for 
operation,  the  cord  not  having  been  subjected  to  other  injury  than 
pressure,  was  most  highly  encouraging,  and  I  cannot  but  think 
that  if  the  after-treatment  had  been  different  he  would  probably 
have  recovered." 

Dr.  J.  Ehea  Barton  performed  the  operation  with  as  good  results 
as  those  obtained  by  Tyrrell,  as  shown  by  the  following  account : 
"J.  P.  was  received  in  the  Pennsylvania  Hospital,  August  18, 1824, 
with  a  fracture  of  the  spine,  caused  by  a  fall  from  the  mast-head  of 
a  brig.  The  lower  part  of  the  trunk  and  the  inferior  extremities 
were  totally  paralyzed.  He  continued  in  this  state,  discharging 
his  feces  and  urine  involuntarily,  until  the  30th  of  August,  when 
Dr.  Barton  performed  the  following  operation :  An  incision  was 
made,  about  eight  inches  in  length,  immediately  over  the  injured 
vertebras.  He  found  the  spinous  process  and  arched  portion  of  the 
seventh  dorsal  vertebra  broken  off  and  depressed  on  the  spinal 
marrow.  When  this  was  done,  it  was  ascertained  that  the  bodies 
of  the  seventh  and  eighth  dorsal  vertebras  were  dislocated  from 
each  other,  without  any  fracture  but  that  above  mentioned.     Lint 

1  See  the  account  given  of  this  case  hy  Georgii,  who  witnessed  the  operation,  in 
the  work  of  Ollivier  d'Angers,  Traite  des  Maladies  de  la  Moelle  epin.,  3d  ed.,  1837, 
vol.  i.  p.  381. 

2  A  System  of  Surgery,  hy  J.  M.  Chelius,  translated  hy  J.  F.  South,  London, 
1845,  vol.  i.  p.  540. 


254  APPENDIX. 

was  laid  over  the  wound.  The  paralysis  not  being  immediately 
relieved,  it  was  inferred  that  compression  was  kept  up  by  blood 
effused  within  the  spinal  canal,  which  would  possibly  escape  with 
the  suppuration  from  the  wound.  About  forty-eight  hours  from 
the  time  of  the  operation,  sensibility  began  to  return  below  the 
injured  vertebra?,  and  gradually  extended  toward  the  toes  until  the 
third  day,  when  he  was  attacked  with  a  violent  chill,  which  con- 
tinued, notwithstanding  all  the  stimulant  medicines  given,  until  his 
death,  which  occurred  in  twelve  hours  from  its  commencement. 
On  opening  the  thorax,  the  posterior  mediastinum  was  found  filled 
by  about  half  a  gallon  of  coagulated  blood,  which  accounts  for  the 
difficulty  of  respiration,  especially  when  he  lay  on  his  back.  This 
being  cleared  away,  the  condition  of  the  vertebral  column  was  seen. 
The  seventh  and  eighth  dorsal  were  injured  as  before  stated,  the 
body  of  the  ninth  was  fractured,  and  blood  was  effused  throughout 
the  spinal  canal."1 

In  this  case  death  was  most  likely  due  to  the  loss  of  blood  com- 
bined with  the  difficult}'  of  breathing.  In  the  following  case  we 
will  find  also  that  the  operation  was  followed  by  good  results  as 
regards  the  functions  of  the  spinal  cord. 

In  the  next  case  the  result  of  surgical  interference  was  extremely 
marked.  A  strongly-built  young  man,  having  been  struck  on  the 
neck,  was  brought  to  a  hospital.  Symptoms  of  fracture  of  the 
spine  were  observed.  Three  months  and  a  half  after  the  accident. 
Dr.  A.  Potter,  of  New  York,  saw  the  patient  and  found  him  paralyzed 
both  as  to  sensibility  and  motion  in  all  the  parts  below  the  seat 
of  the  fracture.  Dr.  Potter  thought  that  there  was  compression  of 
the  spinal  cord  by  the  broken  pieces  of  bone,  and  proposed  to  raise 
or  extract  these  pieces.  The  next  day  he  performed  the  operation, 
and  took  away  several  pieces  belonging  to  the  last  four  cervical 
and  the  first  two  dorsal  vertebra?.  The  patient  recovered  sensibility 
almost  immediately,  and  a  few  hours  after  he  could  easily  say  ichat  foot 
and  what  toe  were  touched.  The  wound  was  in  the  way  of  healing, 
when  a  thoracic  inflammation,  which  existed  before  the  operation, 
increased  rapidly,  and  caused  the  death  of  the  patient,  eighteen 
days  after  the  operation.2 

This  case  is  a  most  important  one,  as  it  clearly  shows,  1st.  That 

1  J.  D.  Godman's  edition  of  Sir  A.  Cooper's  Treatise  on  Dislocations  and  Frac- 
tures, p.  421 ;  see  also  Packard's  translation  of  Malgaigne,  p.  343. 

2  See  Gaz.  Med.  de  Paris.  1S45.  p.  74S.  or  Xew  York  Journal  of  Medicine.  March, 
1845. 


APPLICATION    OF    FOREGOING    VIEWS    TO    SURGERY.      255 

the  extraction  of  broken  pieces  of  vertebrae  has  been  followed  by 
a  complete  return  of  sensibility ;  2d.  That  cicatrization  of  the 
wound  due  to  this  operation  may  proceed  rapidly ;  3d.  That  the 
operation  had  proved  in  a  great  measure  successful,  and  that  the 
cause  of  death  was  altogether  independent  from  it.  The  following 
case,  though  less  important  than  the  preceding,  is  a  very  interest- 
ing one. 

A  man  fractured  his  spine  in  the  cervical  region.  His  breathing 
was  performed  by  the  diaphragm  alone;  sensibility  and  motion 
were  lost  everywhere  in  the  trunk  and  lower  limbs ;  the  bladder 
was  paralyzed  ;  pulse  very  low.  He  became  gradually  worse,  and, 
five  days  after  the  accident,  Mr.  G.  M.  Jones,  of  Guernsey,1  took 
away  the  posterior  arches  of  the  fifth  and  sixth  cervical  vertebrae. 
"  The  pulse  after  the  operation  rose  to  80,  and  no  longer  inter- 
mitted. At  8  P.  M.  the  patient  had  entirely  recovered  from  the 
effects  of  chloroform ;  merely  complained  of  smarting  pain  in  the 
neck  and  back;  was  perfectly  cheerful,  and  had  entirely  recovered 
sensation  as  low  down  as  the  umbilicus.11  He  recovered  also  the 
power  of  raising  his  arms,  and  he  could,  without  inconvenience, 
throw  them  across  the  chest.  During  the  first  succeeding  clays  the 
improvement  continued,  and  Mr.  Jones  had  some  reason  to  hope 
that  recovery  might  take  place,  when  suddenly,  after  the  nurses 
had  changed  the  linen  of  the  patient,  he  was  attacked  with  "coma," 
and  died  shortly  after.  The  autopsy  showed  that  there  was  con- 
siderable effusion  at  the  base  of  the  skull. 

"Whatever  may  have  been  the  real  cause  of  death  in  the  above 
case,  it  is  certain  that  it  is  not  to  be  found  in  the  operation  or  any 
of  its  effects.  We  find,  in  this  last  case  as  in  all  the  preceding, 
that  the  laying  bare  of  the  spinal  cord,  instead  of  being  followed 
by  any  grave  symptom,  was  followed  by  a  return  of  some  of  the 
functions  of  this  nervous  centre,  especially  as  a  conductor  of  sensi- 
tive impressions. 

Two  cases  of  operation  upon  the  spine  after  a  fracture  have  been 
published  in  Germany;  they  both  show  the  importance  of  this 
operation.  In  one  of  them,  the  patient  was  operated  upon  by  Dr. 
A.  Mayer,  of  Wurzburg.2  There  was  a  notable  amelioration  in 
the  symptoms,  but  the  patient,  after  a  fortnight,  died  from  disease 
of  the  lungs.     In  the  other  case  the  patient,  after  a  fracture  of  the 

1  See  Medical  Times  and  Gazette,  July,  1856,  p.  86. 

2  Journal  der  Chirurgie,  von  Walther  und  Ammon,  vol.  xxxviii.  1848,  p.  178. 


256  APPENDIX. 

eleventh  and  twelfth  dorsal  vertebras,  had  a  complete  paraplegia, 
with  retention  of  urine,  vomiting  and  vertigo.  He  was  seen  first 
on  the  thirteenth  day  by  Dr.  Holscher.  He  found  a  slough  begin- 
ning on  the  sacrum,  and  a  notable  depression  at  the  level  of  the 
fracture.  After  having  made  a  crucial  incision,  and  exposed  the 
bones  to  view,  he  took  away  the  posterior  arch  of  the  eleventh 
and  twelfth  vertebrae,  and  removed  a  little  coagulated  blood.  The 
sloughing  healed  after  considerable  exfoliation.  In  six  weeks  the 
wound  of  the  operation  had  healed  well.  Eight  weeks  after  the 
injury,  sensibility  reappeared  in  the  dorsum  of  the  foot,  and  after- 
wards higher  up.  A  few  weeks  later,  the  patient  moved  the  legs 
a  little.  After  twelve  weeks,  he  was  capable  of  raising  himself  up 
in  his  bed,  and  of  moving  slightly  the  lower  limbs ;  but  after  that 
time  his  strength  diminished.  He  had  oedema  in  his  feet,  ascites, 
and  hydrothorax.  He  died  fifteen  weeks  after  the  fracture,  and 
besides  the  anasarca,  there  was  found  pericardial  dropsy.  The 
spinal  membranes  were  denser  and  more  vascular  at  the  place  of 
the  operation,  and  there  were  ligaments  uniting  the  bony  parts ; 
the  spinal  cord  seemed  healthy.1 

We  will  mention  but  one  more  case,  that  of  a  man  wrho  had  a 
fracture  of  the  ninth  dorsal  vertebra,  and  on  whom  Professor  Lau- 
gier2  practised  trepanation.  In  this  case  the  spinal  cord  had  been 
ruptured,  and  therefore  there  was  no  chance  of  a  return  of  sensation 
and  motion  in  the  lower  limbs,  but  respiration  became  easier,  lie  felt 
desire  of  voiding  the  bladder,  and  had  abundant  stools.  Four  days 
after  the  operation  the  patient  died,  chiefly  from  a  pleuro-pneu- 
monia  caused  by  a  fractured  rib. 

We  cannot  but  agree  with  Jaeger,3  who,  concluding  from  some  of 
the  above  facts,  and  also  from  some  others  recorded  by  Attenbur- 
row,  Holscher,  Wickham,  and  Sogers,  declares  that  after  the  opera- 
tion of  trephining  or  removing  broken  pieces  of  bone,  there  is  not 
any  aggravation,  but  rather,  in  most  cases,  a  notable  improvement, 
with  restoration  of  motion  or  sensibility. 

To  the  above  cases  I  might  add  an  interesting  one,  not  of  frac- 
ture, but  of  dislocation  of  the  fourth  cervical  vertebra.  An  incision 
was  made,  and  it  was  found  that  there  was  no  fracture.  The  re- 
duction of  the  luxation  was  performed,  and  the  patient  improved 

1  Hannoverschen  Annalen,  vol.  iv.  p.  330,  1839. 

2  Bulletin  Chirurgical.  1839,  vol.  i.  p.  401. 

3  Cited  by  Chelius  (A  System  of  Surgery,  translated  by  J.  F.  South,  1845,  vol.  i. 
p.  538). 


APPLICATION    OF    FOREGOING    VIEWS    TO    SURGERY.      257 

after  it.  ITe  died,  however,  on  the  sixth  day,  from  a  hemorrhage 
in  the  spinal  cord.1 

The  objections  brought  forward  against  trephining  in  cases  of 
fractured  spine  by  Sir  Charles  Bell,  Sir  Benjamin  Brodie,  and 
others,  have  probably  prevented  many  surgeons  performing  this 
operation.  Already  Mr.  J.  S.  South2  has  convincingly  refuted  some 
of  these  objections;  consequently,  we  will  say  but  little  of  them, 
inasmuch,  also,  that  any  reader  who  will  weigh  carefully  the  argu- 
ments we  have  advanced  in  favor  of  the  operation,  will  find  in 
them  a  sufficient  reply  to  most  of  the  objections  of  Bell,  Brodie, 
and  others.  The  following  objections  are  those  which  alone  deserve 
to  be  noticed  : — 

1st.  It  has  been  said  that  it  is  dangerous  to  expose  the  spinal 
cord  or  its  membranes  to  the  action  of  the  air.  We  have  at  length 
shown  how  erroneous  is  this  opinion. 

2d.  It  has  been  objected  that  the  parts  divided  to  lay  bare  the 
spinal  cord  will  necessarily  become  inflamed,  and  that  the  inflam- 
mation may  be  propagated  to  the  membranes  of  the  cord.  Experi- 
ments on  animals  and  the  cases  of  trephining  in  man,  do  not  show 
any  case  of  meningitis  due  to  such  a  cause.  Besides,  there  is  much 
more  danger  of  inflammation  from  the  laceration  existing  in  a 
fracture  than  from  a  clean  cut. 

3d.  It  has  been  objected  that  we  often  do  not  know  whether 
there  is  a  fracture  of  the  posterior  arch  of  the  vertebras  or  only  of 
their  body.  Surely  a  mistake  may  be  made  in  fthat  respect,  but  the 
laying  bare  of  the  spinal  cord  may  be  useful  in  allowing  the  escape 
of  the  bloody  fluid  effused  in  the  vertebral  canal.  At  any  rate,  the 
worst  would  only  be  that  an  operation,  which  is  not  dangerous, 
has  been  performed  without  profit. 

4th.  It  has  been  said  that  the  pressure  upon  the  spinal  cord, 
after  a  fracture  of  the  spine,  being  due,  in  a  great  many  cases,  to 
the  body  of  the  vertebras,  sometimes  even  when  some  other  part 
of  these  bones  are  fractured,  the  removal  of  a  portion  of  the  pos- 
terior arch  or  its  raising  up  would  not  change  the  situation  of  the 
body  of  the  vertebras.  It  is  true  that  there  would  be  no  change, 
but  certainly  we  need  not  insist  upon  the  fact  that  if  there  is  no 
resistance  on  the  back  part  of  the  cord,  there  will  be  no  compres- 
sion by  a  displaced  bone  forward,  as  the  cord,  being  movable,  will 
simply  be  pushed  backward. 

1  Catalogue  of  Boston  Museum,  1847  ;  case  of  Dr.  William  J.  Walker,  p.  25. 

2  Ibid. 

R 


253  APPENDIX. 

5th.  It  has  been  objected  that,  in  many  cases  of  fractured  spine, 
we  do  not  know  whether  the  spinal  cord  is  considerably  injured  or 
not.  It  is  true  that  if  the  paralysis  of  movement  and  sensibility  is 
complete,  it  will  be  very  difficult  and  sometimes  impossible  to  say 
what  is  the  extent  of  the  injury  to  the  spinal  cord.  But  there  is 
no  reason  not  to  perform  the  operation  on  account  of  our  ignorance 
of  the  condition  of  the  spinal  cord,  as  the  object  of  the  operation  is 
to  give  a  chance  of  saving  a  life  which  otherwise  would  be  lost. 

6tb.  It  has  been  said  that,  after  having  taken  away  the  posterior 
arch  of  one  or  two  vertebrae,  the  spine  would  not  be  sufficiently 
strong  to  support  the  body.  The  three  cases  of  cure  we  have  re- 
ported show  that  this  objection  should  not  be  minded. 

7th.  Mr.  Malgaigne  calls  this  operation  "  a  desperate  and  blind 
one,"1  and  he  adds  that  he  would  not  advise  any  one  to  perform  it. 
He  does  not  give  the  reasons  of  his  opinion  against  it,  and  contents 
himself  with  simply  asserting  that  "it  has  always  been  undertaken 
at  great  risk,  and  has  never  been  justified  by  the  results."  As  clearly 
shown  by  the  facts  we  have  related,  the  truth  is  that  this  operation 
has  always  been  undertaken  without  any  great  risk,  and  that  it  has  fre- 
quently been  quite  justified  by  the  results.  Mr.  Malgaigne  says,  in 
answer  to  Sir  Astley  Cooper,  who  has  written  in  favor  of  trepana- 
tion of  the  spine,  that  "  it  is  not  accurate  to  call  it  our  only  scien- 
tific resource.  In  every  fracture  writh  displacement,  the  most 
scientific  and  rational  plan  is  first  to  attempt  reduction  by  the 
ordinary  methods ;  and  to  this  rule  fractures  of  the  vertebras  do 
not  constitute  an  exception."  We  know  full  well  that  several 
surgeons  (Ehrlich,  Schub,  Wittfeld,  Tuson,  Stafford,  and  others2) 
have  related  cases  of  fracture  and  luxation  of  the  spine  successfully 
treated  by  extension  and  reduction ;  but  we  know  also  that  there 
is  on  record  at  least  one  case  of  sudden  death  caused  by  the  efforts 
at  reduction,3  and  we  feel  very  much  inclined  to  repeat  with  Mr. 
South,4  "that  the  attempt  to  set  a  fracture  through  the  body  of  a 
vertebra,  accompanied,  as  it  almost  invariably  is,  with  displacement, 
and  most  commonly  with  fracture  of  the  vertebral  arch,  or  articular 
processes,  is,  as  Chelius  says,  most  highly  dangerous  and  ought 
never  to  be  attempted."     No  doubt  that  the  reduction  may  some- 

1  Packard's  above  quoted  translation,  p.  345. 

2  See  the  good  dissertation  of  Ricliet :  Des  Luxations  Traumatiques  du  Rachis, 
1851,  p.  85. 

3  See  Traite  des  Maladies  Chirurgicales,  par  Boyer,  5th  ed.,  vol.  iii.  p.  650. 
Loc.  cit.,  p.  538. 


APPLICATION    OF    FOREGOING    VIEWS    TO    SURGERY.      259 

times  succeed  admirably,  but  in  some  cases  this  operation  might 
be  the  cause  of  a  more  or  less  extensive  crushing  or  laceration  of 
the  spinal  cord. 

Conclusions  from  the  above  Clinical  Facts  and  Experiments. — It  is 
quite  evident  that  the  laying  bare  of  the  spinal  cord  is  not  a  dan- 
gerous operation.  Experiments  upon  animals,  and  clinical  facts 
observed  in  man,  agree  completely  in  giving  a  demonstration  of  the 
exactitude  of  this  assertion.  It  is  evident,  also,  from  the  results  of 
experiments  and  from  clinical  facts,  that  the  operation  of  trephining 
gives  a  chance  of  saving  the  life  of  patients  in  whom  one  or  several 
vertebra  are  broken,  so  that  if  we  take  notice  of  the  fact  that  most 
patients  are  sure  to  die  after  a  fracture  of  the  spine,  especially  in 
the  neck  or  in  the  upper  part  of  the  dorsal  region,  we  cannot 
understand  why  this  operation  has  been  so  rarely  performed.  In- 
deed, it  is  surprising  that  a  man  is  allowed  to  die  without  any 
attempt  to  save  his  life,  by  an  operation  which  is  neither  dangerous 
nor  very  difficult. 

It  is  evident,  also,  that  operations  which  are  not  dangerous,  and 
which  may  save  the  life  of  three  or  four1  patients  out  of  a  number  of 
sixteen  or  seventeen,  i.  e.,  nearly  20  per  100,  should  not  be  neglected. 
The  percentage  of  cure  after  these  operations,  compared  to  the 
percentage  of  cure  (perhaps  less  than  1  per  100)  when  neither  of 
them  is  performed,  shows  clearly  the  importance  of  such  kinds  of 
surgical  interference  after  fracture  of  the  spine. 

Three  distinct  operations  may  be  performed  on  the  spine  in 
cases  of  fracture :  1st.  The  extirpation  of  broken  pieces  of  bone ; 
2d.  The  raising  up  or  lifting  out  of  the  posterior  arch  of  one  or 
several  vertebra,  when  they  press  upon  the  spinal  cord ;  3d.  The 

1  To  the  cases  of  cure  above  recorded,  I  would  have  added  the  interesting  case 
published  by  Dr.  J.  B.  Walker,  of  Boston,  had  the  seat  of  the  fracture  been  indi- 
cated with  more  precision.  A  man  was  struck  upon  the  back  of  the  neck,  and 
immediately  lost  all  power  of  motion  and  sensation  below  the  middle  of  the  chest. 
The  next  day  an  incision  was  made  over  the  back  of  the  neck,  and,  the  muscles 
having  been  dissected  away,  it  was  found  that  the  spinous  process  of  the  sixth 
cervical  vertebra  was  fractured  and  quite  loose,  though  not  driven  in ;  the  bone 
was  seized  and  twisted  away.  The  wound  was  closed  by  four  sutures,  and  healed 
without  any  trouble.  On  the  third  day  from  the  operation,  there  was  some  return 
of  sensibility,  and  twelve  days  later  it  was  reported  as  quite  natural.  The  power 
of  the  bladder  partly  returned,  and,  although  symptoms  of  myelitis  appeared,  he 
recovered  some  power  upon  the  lower  limbs.  Two  years  afterwards,  his  condition 
was  stationary.  His  general  health  was  very  good.  ( Catalogue  of  the  Museum  of 
the  Boston  Society  for  Medical  Improvement,  by  J.  B.  S.  Jackson,  1847,  p.  31.) 


260  APPENDIX. 

application  of  the  trephine.  Examples  of  each  of  these  three 
operations  have  been  reported  above.  These  various  operations, 
or  one  or  two  of  them,  ought  to  be  employed  in  almost  all  cases 
of  fracture  of  the  spine,  especially  in  the  cervical  region,  and  in 
the  upper  parts  of  the  dorsal  region,  where  pressure  upon  the 
spinal  cord  is  attended  with  so  much  danger.  The  operation 
should  be  performed  as  quickly  as  possible  after  the  fracture,  and 
before  inflammation  has  set  in.  If,  after  having  laid  bare  the 
spinal  cord,  it  is  found  necessary  to  reduce  a  fracture  of  the  body 
of  one  or  several  vertebrae,  the  reduction  will  then  be  much  easier, 
and  attended  with  much  less  danger  than  if  the  vertebral  canal  had 
not  been  opened  in  its  back  part. 

In  concluding  these  remarks  upon  trephining  in  cases  of  fractured 
spine,  we  cannot  do  better  than  to  repeat  these  sentences  of  Sir 
Astley  Cooper:  "The  proposal  is  laudable,  and  the  operation  is  not 
severe,  nor  does  it  increase  the  danger  of  the  patient ;  time  and  ex- 
periment can  only  determine  its  value.  If  we  could  save  one  life 
in  a  hundred  by  it,  we  should  deserve  well  of  mankind ;  and  if  any 
good  does  ultimately  result  from  it,  Henry  Cline  has  the  merit  of 
proposing  it."1  To  this  we  will  only  add  that  three  or  four  lives 
have  been  saved  already  by  that  or  by  kindred  means,  and  it  is 
high  time  that  surgeons  should  put  aside  their  fear  of  compromis- 
ing themselves,  and  rather  expose  their  reputation  than  allow  a 
man  to  die  whom  they  have  a  chance  to  cure. 

II.  Prevention  and  Treatment  of  Sloughs  on  the  Sacrum,  Nates,  etc., 
in  Cases  of  Fracture  of  the  Sjnne,  Myelitis,  Meningitis,  etc. — I  will 
not  insist  upon  this  point:  I  only  wish  to  say  that,  led  by  the 
knowledge  of  facts  showing  the  influence  of  nerves  upon  nu- 
trition through  their  action  upon  bloodvessels,  I  have  tried  to 
prevent  or  to  cure  those  sloughs  which  are  an  evident  result  of 
disturbance  of  nutrition  due  to  an  irritation  of  nerves  of  blood- 
vessels, by  acting  upon  the  bloodvessels  of  the  part  where  sloughs 
exist.  I  have  made  many  experiments  upon  animals,  showing  that 
by  applying  alternately  two  poultices,  one  of  pounded  ice,  the  other 
a  very  warm  bread  or  linseed  poultice,  there  is  a  rapid  cure  of 
sloughs  due  to  a  nervous  irritation.  Several  medical  men  have 
already  obtained  the  same  result  in  man  that  I  have  obtained  in 

1  Lectures  on  Surgery,  p.  16.  Sir  Astley  is  mistaken  in  saying  that  Cline  lias 
the  merit  of  having  proposed  this  operation.  Many  surgeons  had  made  the  pro- 
position long  before  Cline. 


RATIONAL  TREATMENT  OF  HYDROPHOBIA.      261 

animals,  in  following  the  plan  of  treatment  that  I  have  proposed. 
The  pounded  ice,  kept  in  a  bladder,  is  applied  for  eight  or  ten 
minutes,  and  the  warm  poultice  for  an  hour  or  two,  or  even  a  longer 
period.  It  is  especially  in  cases  of  fracture  of  the  spine,  or  of 
myelitis,  that  this  mode  of  treatment  would  be  employed  with  great 
success.  As  it  is  certain  that  when  they  are  not  quickly  the  cause 
of  death,  fractures  of  the  lower  part  of  the  spine  destroy  life 
chiefly  through  the  production  of  sloughs,  and  the  propagation  of 
the  inflammation  to  the  fibrous  structures  of  the  sacrum,  and 
thence  to  the  spinal  meninges,  it  will  easily  be  understood  how  im- 
portant it  would  be  to  make  use  of  the  means  I  have  just  spoken 
of,  against  sloughs.  I  think  I  can  safely  say  that,  in  cases  when  a 
slough  is  beginning,  its  progress  will  always  be  stopped  by  the 
means  I  propose. 

III.  Rational  Treatment  of  Burns. — I  have  shown,  in  one  of  the 
preceding  lectures,  that  burns  are  very  often  fatal,  on  account  of 
the  reflex  disturbance  of  nutrition  that  they  produce,  by  a  reflex 
action  in  one  or  several  of  the  thoracic,  abdominal,  or  cranial  vis- 
cera. (See  Lecture  X.,  pp.  161,  171,  and  175.)  I  will  only  say 
now,  that  of  the  various  modes  of  treatment  of  burns  there  is  one 
which  has  given  admirable  results  at  the  great  military  hospital  of 
Paris,  the  Vol  de  Grdce,  and  theoretically  there  is  no  better  means. 
As  the  principal  object  of  the  treatment  is  to  prevent  reflex  influ- 
ences and  pain,  the  best  therapeutical  means  consists  in  applica- 
tions of  ice  upon  the  burnt  part.  But,  as  it  has  been  found  long 
ago,  applications  of  cold,  if  once  made,  must  be  continued  without 
interruption.1  Cold,  by  diminishing  considerably  the  vital  proper- 
ties of  the  nerves,  will  prevent  pain,  and,  what  is  more  important, 
those  reflex  influences  which  are  so  often  the  causes  of  death  after 
burns.  I  need  not  repeat  here  what  I  said  (pp.  175, 176),  that  bella- 
donna is  the  best  narcotic  to  be  employed  in  cases  of  burns,  as  it 
is  the  most  powerful  agent  to  diminish  the  reflex  power  of  the 
spinal  cord.  Opium  must  be  avoided,  not  only  because  it  produces 
congestion  of  the  brain,  but  also  because  it  increases  the  reflex 
power  of  the  spinal  cord. 

IV.  Rational  Treatment  of  Hydrophobia. — We  only  wish  to  say  a 
few  words  on  this  most  important  subject.  The  facts  and  views 
exposed,  in  several  of  our  lectures,  on  the  production  of  nervous 

1  See  the  Notes  of  Mr.  South,  in  his  translation  of  Chelius'  Surgery,  vol.  i.  pp. 
112,  113. 


262  APPENDIX. 

diseases  by  an  irritation  starting  from  the  periphery  of  the  body, 
tend  to  show  that  tetanus,  epilepsy,  hysteria,  catalepsy,  chorea,  etc., 
may  have  their  origin  in  an  irritation  on  some  peripheric  part  of  a 
nerve.  "We  think  it  is  so,  also,  as  regards  hydrophobia,  and  if  really 
such  is  the  origin  of  symptoms,  it  seems  rational  to  employ  in  this 
affection,  as  well  as  in  certain  cases  of  tetanus  and  other  convulsive 
diseases,  the  section  of  the  nerve  through  which  the  excitation  is 
transmitted  to  the  nervous  centres. 

This  view  will  certainly  seem  very  strange  to  those  persons  who 
look  upon  hydrophobia  as  the  result  of  the  absorption  of  a  poison, 
which  acts  upon  the  nervous  centres,  through  which  it  circulates 
with  the  blood.  But  if  we  observe:  1st,  that  an  alteration  takes 
place  in  the  part  of  the  body  that  has  been  bitten  by  a  rabid  dog, 
before  the  convulsive  and  other  phenomena  of  hydrophobia  appear; 
2d,  that  the  convulsions  of  hydrophobia  occur  by  fits  following  a 
kind  of  aura  (pain  or  other  sensations)  starting  from  the  wound  of 
the  bite  or  its  cicatrix  (which  very  often  then  gives  way  and  is  re- 
placed by  a  bleeding  or  suppurating  wound) — we  are  forcibly  led 
to  think  that  the  cause  of  hydrophobia  is  in  the  irritation  of  the 
wounded  nerves,  and  cannot  be  an  action  of  a  poison  on  the  nerv- 
ous centres. 

Many  other  facts  lead  to  the  same  conclusion.  The  following  is 
the  most  important.  An  eminent  physician,  Dr.  W.  Stokes,  of 
Dublin,  after  having  heard  a  lecture  I  delivered  last  year  on  this 
subject,  told  me  that  his  father  was  led  by  the  following  fact  to 
admit  the  view  I  hold.  A  tourniquet  having  been  applied  on  a 
limb  of  a  patient  attacked  with  hydrophobia,  the  symptoms  were 
quickly  improved,  and  even  seemed  to  cease  altogether.  The  sur- 
geon then  proposed  to  his  colleagues  to  amputate  the  limb,  but 
they  declined  giving  their  assent  to  this  operation.  It  was  ascer- 
tained several  times  that  so  long  as  the  tourniquet  was  applied 
there  were  no  convulsions,  and  that  they  occurred  at  every  time  it 
was  taken  away.  As  the  danger  of  producing  gangrene  prevented  a 
constant  application  of  the  tourniquet,  the  patient  ultimately  died. 

We  admit  as  everybody  that  there  is  a  poisonous  principle  in 
the  saliva  of  rabid  animals,  but  we  think  that  it  is  in  consequence 
of  changes  produced  locally  in  the  nerves  wounded  by  the  bite, 
that  the  phenomena  of  hydrophobia  occur.  We  arc  told  that  this 
hypothesis  has  been  already  put  forward  by  a  London  surgeon  in 
an  article  published  many  years  ago  in  the  Lancet,  and  that  the 


ADDITIONAL    FACTS.  263 

author  of  this  article  has  proposed  the  division  of  the  wounded 
nerve  as  a  means  of  treatment. 

I  think  that  the  first  thing  to  be  done  in  a  case  of  hydrophobia, 
owing  to  a  bite  in  a  limb,  would  be  to  apply  the  tourniquet  upon 
the  principal  artery  of  the  limb,  above  the  wounded  part,  and  if 
there  is  no  tourniquet  at  hand,  to  apply  a  very  tight  ligature  round 
the  upper  part  of  the  limb.  If  the  symptoms  cease  in  consequence 
of  either  of  these  means,  then  I  would  advise  the  resection  of  two 
inches  of  the  trunk  of  the  nerve  that  gives  fibres  to  the  wounded 
part.  But  if  the  patient  is  seen  a  short  time  after  the  bite,  I  would 
advise,  besides  the  application  of  the  heated-iron  to  the  wound,  the 
resection  of  a  part  of  the  nerve  at  a  small  distance  above  the  wound. 
If  the  bite  has  been  made  on  some  part  of  the  head  or  trunk,  I 
would  advise  also  the  resection  of  the  nerve  that  gives  fibres  to  the 
wounded  skin  or  flesh. 

It  may  be  that  patients  will  only  be  temporarily  cured  by  this 
mode  of  treatment,  and  that  the  parts  of  the  poison  that  are  ab- 
sorbed and  circulate  in  the  blood,  will,  after  a  time,  act  upon  other 
nerves  than  the  one  that  has  been  wounded  and  resected ;  but  as 
there  is  no  certainty,  and,  I  might  say,  no  probability  of  such  a 
recurrence  of  hydrophobia,  and  I  do  not  hesitate  in  urging  the 
trial  of  this  mode  of  treatment.  In  a  fatal  affection  like  hydro- 
phobia, anything  that  gives  even  the  slightest  chance  of  a  cure 
should  be  eagerly  tried. 

PART  III.— ADDITIONAL  FACTS  IN  PROOF  OF  SOME  OF  THE  VIEWS  OF  THE 

AUTHOR. 

We  have  stated  in  Lecture  XII.  (see  p.  201),  that  there  is  a  pecu- 
liar kind  of  paralysis  quite  distinct  from  the  ordinary  cases  of 
paratysis,  produced  by  lesions  of  the  encephalon,  and  characterized 
essentially  by  its  being  on  the  side  of  the  seat  of  the  lesion,  instead 
of  being  on  the  opposite  side,  and  we  have  tried  to  prove  that  this 
special  kind  of  paralysis  is  due  not  to  any  immediate  alteration  of 
voluntary  motor  conductors,  but  to  an  irritation  of  some  parts  of 
a  crus  cerebelli  (Fig.  25,  h,  p))  producing  a  paralysis  by  a  reflex 
action  upon  some  other  part  of  the  nervous  centres.  It  is  probable 
that  the  mechanism  of  production  of  this  paralysis  is  just  the  same 
as  that  which  we  have  described  in  our  "  Lectures  on  Paralysis  of  the 
Lower  Extremities,  Philadelphia,  1860,  Lectures  I.  and  II."  We  will 
not  enter  into  any  discussion  on  this  subject  here.     We  only  in- 


264  APPENDIX. 

tend  to  refer  the  reader  to  several  articles  in  which  we  have  related 
facts  in  favor  of  our  view  (see  Journal  de  la  Physiol.,  1858,  vol.  i. 
p.  531  et  seq.,  and  1859,  vol.  ii.  p.  121),  and  to  give  a  short  account 
of  a  case  recently  published  by  Dr.  J.  W.  Ogle. 

Case. — Mrs.  S.,  oet.  46,  had  enjoyed  good  health  until  1848,  when 
she  occasionally  lost  her  sight  for  a  few  seconds  at  a  time,  and  had 
pain  at  the  front  and  vertex  of  the  head ;  afterwards  she  had  epileptic 
seizures  and  became  totally  blind.  Dr.  Ogle  saw  her  in  December, 
1851.  She  was  pale  ;  had  her  mouth  drawn  to  the  right  side  ;  pupils 
dilated;  no  ptosis;  left  ear  deaf ;  very  intelligent ;  incomplete  loss 
of  power  on  the  whole  of  the  left  side  of  the  body,  with  hyperes- 
thesia of  the  face  on  that  side.  At  times  twitching  of  the  left  arm 
(in  March,  1852) ;  the  paralysis  was  then  less  than  it  had  been.  In 
April,  pain,  with  a  feeling  of  numbness  and  stiffness  in  all  the  limbs, 
but  no  anaasthesia  anywhere ;  sense  of  smell  lost  in  the  left  nostril. 
In  September,  loss  of  taste  in  the  left  side  of  the  tongue.  She  re- 
mained in  pretty  much  the  same  condition  until  September,  1856, 
when  she  died,  after  a  violent  fit  of  convulsions,  which  were  almost 
entirely  limited  to  the  left  side  of  the  body. 

Autopsy. — Connected  with  the  anterior  cerebellar  artery  on  the 
left  side  of  the  brain,  there  was  an  aneurism  (see  Fig.  26,  <7,)  of 
about  the  size  of  a  small  nutmeg,  resting  immediately  upon  the  in- 
ferior surface  of  the  left  middle  crus  certhelli,  and  indenting,  although 
very  slightly  indeed,  the  contiguous  structures  of  the  pons  Varolii 
and  left  lobe  of  the  cerebellum,  which  parts,  at  the  point  of  con- 
tact, were  very  superficially  softened.  The  root  of  the  fifth  nerve 
was  pressed  upon  by  the  aneurism,  and  the  facial  nerve  was  stretched 
by  it.1 

We  give  this  summary  of  this  case,  both  because  it  has  been 
recorded  by  a  most  accurate  observer,  and  because  it  may  serve  as 
a  type  of  analogous  cases.  This  case  offers  all  the  principal  fea- 
tures that  may  exist  in  consequence  of  irritations  of  the  cerebellum, 
of  the  trigeminal  nerve,  and  of  the  middle  crus  cerebelli ;  i.  <?.,  loss 
of  sight  in  both  eyes;  loss  of  the  senses  of  smell,  taste,  and  hear- 
ing in  the  corresponding  side;  incomplete  paralysis  and  spasm  in 
the  limbs  of  the  corresponding  side ;  and,  also,  epileptic  seizures. 
We  have  tried  to  show  elsewhere  that  all  these  symptoms  are  simply 
the  results  of  a  reflex  action  of  these  irritations. 

1  See  the  interesting  paper  of  Dr.  Ogle,  in  vol.  xlii.  of  the  "  Medico-Chirurgical 
Transactions  of  the  Royal  Med.  and  Chirurg.  Soc.  of  London,"  1S59. 


ADDITIONAL    FACTS.  265 

We  will  call  the  reader's  attention  to  the  figures  in  Plate  III. 
(Figs.  25  and  26),  representing  the  part  of  the  base  of  the  brain 
which,  being  irritated,  may  produce  the  phenomena  just  mentioned. 
The  part  marked  A,  in  Fig.  25,  is  the  centre  of  the  zone,  the  irrita- 
tion of  which  produces  a  reflex  paralysis  on  the  corresponding  side. 

My  friend,  Dr.  Ogle,  has  also  published  two  other  papers,  which 
contain  many  facts  proving  the  correctness  of  several  of  the  views 
held  in  my  Lectures.  In  one  of  these  papers  he  gives  a  number  of 
clinical  cases,  showing  the  effects  of  the  paralysis  and  of  the  irri- 
tation of  the  cervical  sympathetic  nerve  in  man.1  Iu  the  other 
paper,  he  gives  many  facts  showing  that  the  posterior  columns  of 
the  spinal  cord  are  not  the  conductors  of  sensitive  impressions  to 
the  brain,  and  also  that  the  gray  matter  is  endowed  with  that  func- 
tion. He  relates,  also,  a  most  important  case,  similar  to  those  I 
gave  in  Lecture  VII.  p.  93,  showing  the  conductors  of  sensitive 
impressions  decussate  in  the  spinal  cord.  The  number  of  cases  of 
that  kind  (loss  of  sensibility  in  one  side,  and  loss  of  movement  in 
the  other  side)  will  soon  be  considerable.  Besides  the  case  of  Dr. 
Ogle,  I  could  add  three  others  to  those  I  have  published :  one 
lately  observed  by  myself,2  one  by  Dr.  Lente,3  and  a  third  by  Dr. 
T.  Chew,  of  Baltimore.4 

1  The  Medico-Chirurg.  Transactions,  1858,  vol.  xli. 

2  The  Brit,  and  For.  Medico-Chirurg.  Rev.,  1859. 

3  The  American  Journal  of  the  Medical  Sciences,  Oct.  1S57,  p.  742. 

4  North  American  Medico-Chirurg.  Rev.,  July,  1860,  p.  711. 


LIST  OF  AUTHORS  REFERRED  TO. 


Abercrombie,  pages  80,  81,  102,  110, 

223,  232,  241. 
Abernethy,  167. 
Albers,  158. 
Alcock,  158,  162. 
Alessandrini,  222. 
Andral,  77,  94. 
Annan,  Samuel,  106-8,  201. 
Antoine,  219. 
Aran,  163. 
Arnold,  J.  W.,  9,  10. 
Attenburrow,  256. 

Badin  d'Hurtebise,  165. 

Balbiani.  171. 

Baly,  W.,  19. 

Barras,  162. 

B  artels,  187. 

Barthez,  156,  165,  233. 

Bayle,  233. 

Becquerel,  171. 

Bell,  Sir  Charles.  2-4,  9-12,  14-15,  30, 

45,  77,  105,154,103.  257. 
Bellingeri,  12,  48,  74,  114,  115,  168. 
Bennett,  J.  H..  76,  174,  237-40. 
Berard,  Aug.,  159. 
Bernard,  Claude,  5,  139,  140-142,  148- 

9,  153,  173. 
Bidder,  23,  54. 
Bidloo,  158. 
Bischoff,  214,  221. 
Bceck,  132. 
Bonet,  180. 
Bonnefin,  CI.,  163. 
Bostock,  91. 

Bouillaud,  60,  78, 168, 225, 227,  232",  241. 
Bouley,  154,  171. 
Bourdon,  74. 
Boyer,  7,  101,  258. 


Bowman,  14. 

Brandt,  222. 

Breschet,  171,  219. 

Bright,  R.,  106,  110,  124,  233,  241. 

Broca,  P.,  163,  169. 

Brodie,  Sir  B.  C,  66, 162, 167, 177,  257 

Brondeau,  de,  159. 

Broussais,  109. 

Budd,  W.,  68-9,  126. 

Budge,  J.,  142,  144. 

Burdach,  241. 

Burggrseve,  196. 

Burnet,  94,  198,  232. 

Burserius,  106. 

Cain,  154. 

Calmeil,  12,  22,  30,  223. 

Campbell,  H.  F.,  152,  158. 

Camper,  165. 

Caron,  74. 

Carpenter,  W.  B..  79,  143,  148. 

Carre,  109. 

C  artier,  64. 

Carus,  6. 

Castorani,  154. 

Chapman,  154. 

Charcellay,  110. 

Charcot,  165. 

Chauveau,  34,  37. 

Chelius,  J.  M.,  253,  256,  258. 

Chew,  T.,  265. 

Chomel,  72. 

Clarke,  222. 

,  Lockhart,  15.  24.  53. 


Cline,  17,  260. 
Cloquet,  H.,  155. 
,  J.,  232. 


Colin,  74,  77. 
.  d'Alfort,  153. 


268 


LIST    OF    AUTHORS    REFERRED    TO. 


Combette,  78. 

Cooke,  106. 

Cooper,  Sir  Astley,  31,  48,  254,  2G0. 

,  Stuart,  110. 

Copland,  10G. 

Coste,  J.  B.,  191. 

Cruikshank,  187. 

Cruveilhier,  57-59.  73-4,   77,  87,  110, 

197,  232. 
Curling,  B.,  87,  161. 
Czermak,  148-9,  153,  173. 

Daniellsen,  132. 

Deen,  Van,  31,  1G8.  219. 

Delioux,  167. 

Denmark,  1G7. 

Depaul,  131. 

Desault,  224. 

Deslandes,  155. 

Desmoulins,  216,  225. 

Deval,  157. 

Diemer,  163. 

Donders,  143. 

Dowler,  Bennet,  190,  222. 

Draper,  143. 

Dubois-Reymond,  6. 

Duchenne,  dc  Boulogne.  232. 

Ducros,  171. 

Dundas,  100. 

Dunn,  R.,  78. 

Duplay,  94. 

Dupuy,  141. 

Dupuytrcn,  171. 

Duverney,  232. 

Emmerich,  157,  162. 
Erichsen,  J.  E.,  161, 171. 
Esquirol,  180,  232. 
Eve,  P.  F.,  158,  162. 

Fabricius,  Hildanus,  165. 

Faivre,  E.,  162. 

Farre,  A.,  85. 

Fischer,  W.  W.,  136. 

Fliess,  164. 

Flourens,  6,  30, 188, 193, 194,  226,  227, 

241. 
Fodcra,  12,  30,  31,  32. 
Fouquier,  1G5. 


Fourcault,  171. 
j  Fournier,  84. 
Foville,  77,  78,  197.  240. 
Frank,  J.,  181. 
Frerichs,  1G3. 
Fricault,  74. 
Friedreich,  109,  110. 

i  Gairdner,  153. 
Galen,  29,  31,  32,  33,  47,  187. 
Call,  136. 
Galliet,  ]^)^). 
Gama,  61,  232. 
Gay,  136. 

Gendrin,  102, 110,  231. 
Genest,  72. 

Geoffroy  St.  Hilairc,  Etienne,  215-16. 
,  Isidore,  212. 


Gerdy,  80,  225,  227. 
Gerlach,  171. 
Gluge,  171. 
Gola,  165. 
Goupil,  174. 
Grainger,  229. 
Gratiolet,  54. 
Graves,  1G4,  165. 
Grenet,  110. 
Greuzard,  110,  111. 
Grisolle,  87. 
Guerin,  J.,  219,  222. 
Guersant,  233. 
Guillot,  N.,  160. 
Gull,  W.  W.,  66,  163. 
Guyon,  74,  83. 

Halford,  Sir  II.,  1G7. 

Hall,  Marshall,  115,  152,  184,  192,  225. 

Haller,  A.  de,  29,  47, 168,  241. 

Hardy,  65. 

Harless,  195. 

Hasse,  1G7. 

Hawkins,  C,  138. 

Heer,  Henricus  ab,  181. 

Heine,  164. 

Bempel,  222. 

Henle,  140,  152, 154, 156, 168, 169, 193. 

Henroz,  60. 

Hersent,  74. 

Hildrcth,  212. 


LIST    OF    AUTHORS    REFERRED    TO. 


269 


Hilton,  176. 
Hinton,  196. 
Holscher.  256. 
Holmes,  0.  W.,  219. 
Home,  Sir  E.,  91 
Houston,  148. 
Hutin,  56,  74,  233. 

Inman,  T.,  110,  138. 

Jackson,  J.  B.  S.,  136,  212,  259. 

Jaeger,  256. 

James,  157. 

Jeffreys,  91. 

Jobert,  78, 169. 

Jones,  Handfield,  87. 

,  Wharton.  140,  170. 

Kennedy,  164. 
Kronenberg,  5,  168. 
Kupfer,  54. 
Kussmaul,  143,  183. 

Laboulbene,  82,  86,  126. 
Lafargue,  193. 

Lallemand,  163,  219,  228,  241. 
Landry,  164,  165,  232. 
Laugier,  17. 
Lawrence,  87. 
Lebert,  124,  233,  236. 
Lebret,  193. 
Legallois,  187. 
Lenhossek,  54,  232. 
Lente,  265. 

Leroy,  d'Etiolles,  R.,  106,  164. 
Ley,  H.,  105. 
Liberali,  74. 
Lieutaud,  180,  232. 
Lincke,  195. 
Lister,  174. 
Long,  161,  171. 

Longet,  12-17,  30,  56,  59,  77,  78, 193, 
197,  198,  224,  227,  229,  235,  239-40. 
Lonsdale,  217. 
Lorenz,  187. 
Louis,  251. 
Lorry,  30,  187,  225. 
Ludwig,  148,  153. 
Luys,  67. 


Macario,  164. 
McNaughton,  63. 

Magendie,  4,  6,  8,  18,  35,  89,  90.  171, 

193,  225. 
Maisonneuve,  88. 
Malacarne,  219. 
Malgaigne,  252,  258. 
Malle,  72. 
Marc,  78. 

Marchal,  de  Calvi,  164. 
Marotte,  1G2. 
Martinet,  165. 
Martin-Magron,  193. 
Martini,  141. 
Matteucci,  6-7. 
Mayer,  142. 

Mayo,  Herbert,  115,  163. 
Mazade,  157. 
Metzler,  54. 
Meynier,  163. 
Mistichelli,  197 
Mohr,  94,  198. 
Molmelli,  142. 
Mondiere,  1G7. 
Monod,  96. 

Morgagni,  78,  104,  158,  180. 
Morgan,  Campbell  de,  185. 
Mueller,  J.,  152, 156,  157, 169,  225,  227, 

229,  241. 
Musel,  180. 

Nasse,  F.,  80. 

H..  74. 

W.,  77. 


Nelaton,  97. 

Neucourt,  165,  168. 

Nichet,  74. 

Nonat,  22. 

Notta,  154-55, 157-58, 163,  165,  ] 67. 

O'Brien,  166. 

Ogle,  J.  W.,  74,  87,  110,  138,  264,  265. 

Olier,  214,  216. 

Ollivier,  d'Angers,  61,  74,  81,  88,  91, 

126,  212,  223,  229,  233,  246,  253. 
Ore,  95. 
Oribase,  47. 
Owsjannikow,  54. 


270 


LIST    OF    AUTHORS    REFERRED    TO, 


Paget,  J.,  140,  148,  150,  1G2,  174,  176, 

217. 
Paine.  Martyn,  156,  160. 
Pappenheim,  5. 
Pariset,  233. 
Parrot,  167. 
Parsons,  167. 
Paterson,  237-8. 
Peacock,  238. 
Perrault,  Claude,  168. 
Philipcaux,  21,  108,  233-35. 
Pilcher,  115. 
Poisson,  110. 
Pontier,  181. 
Portal,  91,  180. 

Pourfour  du  Petit,  77,  140-42,  197. 
Prochaska,  156. 
Prus,  74,  86,  90. 

Ramazzini,  106. 

Rayer,  62,  80,  164,  167. 

Reid,  J.,  30,  121-3,  142,  229. 

Reynal,  154. 

Reynolds,  R.,  194. 

Richardson,  B.  W.,  191. 

Richet,  258. 

Richter,  158. 

Rilliet,  164,  233. 

Roberts,  W.,  163. 

Robin,  Ch.,  67. 

Roche,  131. 

Rogers,  256. 

Rolando,  12. 

Romberg,  Hermann,  110. 

,  M.  H.,  110,  132,  163,  167-8, 

232,  241. 
Rostan,  241. 
Rowland,  167. 


Sabouraut,  77. 

Sandras,  74. 

Sarlandiere,  89. 

Saucerotte,  77. 

Savory,  W.  S.,  143. 

Schenck,  158. 

Schiff,  M.,  5,  21,  32,  38,  41,  129,  141, 

143,  158,  193. 
Schceps,  12,  31. 


Schrceder  van  der  Ivolk,  2  : 

Senec,  106. 

Serres,  74,  201,  225,  241. 

Shaw,  Alex.,  3. 

Sichel,  157. 

Sieveking,  87. 

Simon,  G.,  167. 

Simpson,  214. 

Smith,  Alban  W..  252. 

South,  J.  F.,  253.  257,  261. 

Solly,  S.,  30. 

Standert,  185. 

Stanley,  Edward,  68,  87,  116,  164,  232. 

Stilling,  15,  20,  31,  38,  45,  54,  140, 152, 

169,  219. 
Swan,  176. 

Taehcron,  110. 

Tailhe,  80. 

Tenner,  143,  183. 

Tholozan,  139,  146. 

Tiedemann,  168,  221. 

Tissot,  156. 

Todd,  R.  B..  14. 15,  56,  70,  74,  148, 172, 

197,  225,  228. 
Toulmouche,  77. 
Trousseau,  154,  165. 
Tiirck,  L.,  73,  76,  243,  244. 
Turner,  200. 
Tyrrell,  17. 

Valentin,  30,  48,  114-15, 197,  199.  240. 

Vallez,  158. 

Valsalva,  158. 

Velpeau,  74,  78,  223,  233. 

Vierordt,  192. 

Vigues,  99. 

Vogt,  154. 

Volkmann,  5,  192,  219. 

Vulpian,  21,108,  233-35. 

Wade,  Robert,  246. 
Wagner,  R.,  23,  54. 
Waller,  Aug.,  140,  142-3,  144. 
Walker,  Alex.,  3. 
J.  B.,  259. 


Walter,  195. 
Walther,  157. 


LIST    OF    AUTHORS    REFERRED    TO. 


271 


Wardrop,  167. 

Weber,  E.  H.  and  Ed.,  226. 

Webster,  J.,  58,  70. 

West,  164. 

Whytt,  R.,  154,  156,  168. 

Wickham,  256. 


Williams.  C.  J.  B.,  174. 
Wittfeld,  74,  77,  258. 

Yelloly,  31. 

Zabriskie,  165. 


EXPLANATION  OF  THE  PLATES 


PLATE    I. 


Fig.  1. — A,  anterior  roots;  P,  posterior  roots;  g,  ganglion  on  the  posterior 
roots ;  c,  central  parts  of  the  divided  roots ;  d,  distal  parts  of  the  roots. 
The  arrows  show  the  direction  of  nervous  action  in  the  anterior  and  pos- 
terior roots.  (Lecture  I.,  pp.  4  and  5.) 

Fig.  2. —  W,  a  weight  attached  to  I,  the  tendon  of  m,  a  muscle  attached  to  a 
ring  by  its  other  extremity ;  n,  the  nerve  of  m2,  another  muscle  which 
contracts,  when  the  muscle  m  tends  to  contract.   (Lecture  L,  pp.  6  and  7.) 

Fig.  3. — Spinal  cord  of  a  frog. — A,  anterior  roots  ;  P,  posterior  roots  ;  I,  left,  r, 
right  side ;  s,  transversal  section  of  the  spinal  cord ;  c,  central,  and  d, 
distal  parts  of  the  divided  anterior  root  on  the  left  side.  An  irritation 
upon  d,  the  distal  part  of  anterior  root,  produces  in  some  muscles  a  spas- 
modic contraction,  which  excites  the  sensitive  or  excito-motory  nerves  of 
these  muscles  ;  the  spinal  cord  receives  the  excitation  of  these  nerves,  and, 
through  other  anterior  roots,  reflects  it  to  some  muscles  of  the  right 
side,  which  then  contract.  The  arrows  show  the  direction  of  nervous 
action.  (Lecture  I.,  p.  6,  and  Lecture  III.,  p.  35.) 

Fig.  4. — Spinal  cord  of  a  mammal. — s,  a  transversal  section  of  a  lateral  half  of 
the  cord;  P,  sensitive  roots  decussating  in  the  spinal  cord;  A,  anterior 
roots  on  the  right  side ;  I,  left,  and  r,  right  sides.  The  arrows  indicate 
the  direction  of  nervous  action.  It  sometimes  occurs  that,  in  irritating 
the  sensitive  nerves  on  the  left  side,  which  has  lost  its  sensibility,  there 
is  a  spasm  on  the  right  side,  due  to  a  reflex  action,  and  as  the  spasmodic 
contraction  excites  the  sensitive  nerves  of  the  muscles  in  which  it  takes 
place,  and  as,  besides,  these  nerves  are  in  a  state  of  hyperesthesia,  there 
is  a  sensation  of  pain.  When  the  posterior  roots  are  divided  on  the  right 
side,  there  is  no  sign  of  pain  when  the  left  side  is  irritated.  (Lecture  I., 
p.  6,  Lecture  III.,  p.  35.) 

Fig.  5. — c,  cerebellum  ;  p,  a  pin,  part  of  which  has  passed  through  the  left  resti- 
form  body,  the  descending  fibres  of  the  large  or  sensitive  root  of  the  trige 
minal  nerve,  and  the  left  anterior  pyramid ;  v,  the  Fof  gray  matter,  the  pre- 
tended vital  knot ;/,  the  floor  of  the  fourth  ventricle.  (Lecture  II.,  p.  18.) 

Fig.  6. — Sections  of  the  posterior  columns  of  the  spinal  cord,  and  formation  of 
upper  and  lower  segments  of  these  columns. — In  the  four  figures,  a  is 
the  upper  or  cephalic  segment,  and  b  the  lower  or  caudal.     In  the  2d,  3d, 

S 


274  EXPLANATION    OF    THE    PLATES. 

and  4th  figures,  s  is  a  section  of  the  posterior  columns.  In  the  4th  figure, 
s  is  a  section  of  the  anterior  columns.  In  the  four  figures,  a'  represents 
the  anterior  columns,  p,  the  posterior,  and  g,  the  gray  matter.  (Lecture 
II.,  pp.  24-26.) 

Fig.  7. — Two  figures,  1  and  2,  showing  a  double  section  of  the  posterior  co- 
lumns, p.  In  the  figure  on  the  left  side,  the  two  sections  s,  s,  are  far 
one  from  the  other ;  in  the  figure  on  the  right  side,  they  are  very  near, 
and  the  roots  of  only  one  pair  of  nerves  are  between  them.  (Lecture  II., 
p.  26.) 

Fig.  8. — p,  p,  posterior  columns  of  the  spinal  cord;  s,  transversal  section  of 
these  columns;  d,  a  transversal  section  of  the  whole  cord,  except  the 
posterior  columns  ;  r,  ?•',  /•",  the  posterior  roots  of  the  three  pairs  of  nerves 
below  the  last  section.  (Lecture  II.,  pp.  21,  28.) 


PLATE    II. 

Fig.  9. — s,  s',  transversal  sections  of  the  right  and  left  lateral  halves  of  the  spi- 
nal cord  ;  f,f,  conductors  of  sensitive  impressions  decussating  along  the 
median  line  ;  I,  left,  r,  right  sides.  (Lecture  III.,  p.  31.) 

Fig.  10. — p,  posterior  columns ;  r,  right  side,  I,  left  side  ;  s,  section  of  the  whole 
right  lateral  half  of  the  cord  ;  s',  section  of  the  left  posterior  column  at 
the  level  of  the  preceding  section ;  1,  2,  3,  pairs  of  nerves  below  the  sec- 
tions. (Lecture  III.,  p.  32.) 

Fig.  11. — Spinal  cord  of  a  rabbit. — I,  left  side  ;  ri,  right  side  ;  /,  longitudinal  sec- 
tion of  the  brachio-cervical  enlargement  of  the  cord ;  s,  transversal  sec- 
tion of  the  right  lateral  half  of  this  enlargement ;  r,  r',  r",  posterior  roots 
of  nerves  decussating  along  the  median  line.  (Lecture  III.,  p.  34,  and 
Lecture  VI.,  p.  90.) 

Fig.  12. — I,  left  side,  r,  right  side  ;  V ',  longitudinal  section  of  the  spinal  cord ;  s, 
transversal  section ;  1,  2,  3,  4,  the  posterior  roots  of  the  spinal  nerves  be- 
hind the  transversal  section.  (Lecture  III.,  p.  36.) 

Fig.  13. — Transversal  sections  of  the  spinal  cord  of  the  guinea-pig,  magnified 
four  diameters. — P,  posterior  columns  :  -4.  anterior  columns  :  p  r,  posterior 
roots  ;  a  r,  anterior  roots.  In  Xos.  2,  3,  4,  5,  the  black  surfaces  represent 
the  divided  parts  of  the  spinal  cord.   (Lecture  IV.,  pp.  46,  48.) 

Fig.  14. — Transversal  section  of  the  spinal  cord. — P,  posterior,  and  A,  anterior 
columns ;  L,  lateral  column ;  p  r,  posterior,  and  a  r,  anterior  roots  of  a 
pair  of  nerves  ;  g,  ganglion.  The  dark  lines  show  the  passage  of  the  pos- 
terior roots  into  the  posterior  and  lateral  columns,  and  of  the  anterior 
roots  into  the  anterior  and  lateral  columns,  through  the  gray  matter. 
Some  of  the  anterior  and  of  the  posterior  roots  decussate  in  the  gray 
matter.  (Lecture  V.,  p.  54.) 

Fig.  16. — Transversal  section  of  the  spinal  cord  of  man.—/,  posterior  roots;  a, 
anterior  roots ;  a  I,  altered  part  of  one  of  the  posterior  and  lateral  co- 
lumns. (Lecture  V.,  p.  73.) 

Fig.  17. — Transversal  section  of  the  spinal  cord  of  man. — p.  posterior,  and  a, 
anterior  root;  a  I,  altered  parts  of  the  two  posterior  columns.  (Lecture 
V.,  p.  73.) 


EXPLANATION    OF    THE    PLATES.  275 

Fig.  18  — c,  the  right  lateral  half  of  the  cerebellum.  The  floor  of  the  fourth 
ventricle  is  seen.  The  dotted  lines,/,/,  represent  the  conductors  of  sen- 
sitive impressions,  according  to  the  hypothesis  of  Longet ;  /,  fibres  which 
do  not  pass  through  the  cerebellum  ;  n,  t,  tubercula  quadrigemina  ;  r,  left 
and  r',  right  restiform  body.  (Lecture  VI.,  p.  77,  and  Lecture  XII.,  pp. 
198  and  200.) 


PLATE    III. 

Fig.  19. — Represents  a  tumor  on  the  spinal  cord. — t,  t,  tumor  in  one  part  entire 
upon  p,  the  posterior  surface  of  the  cord,  and  in  the  other  part  divided 
longitudinally  ;  a,  the  atrophied  part  of  the  spinal  cord ;  m,  the  meninges. 
(Lecture  VI.,  p.  86.) 

Fig.  20. — In  these  three  figures,  the  black  part  represents  the  blood  effused  in 
the  gray  matter.  At  1,  the  section  has  been  made  immediately  below  the 
cervico-brachial  enlargement,  at  the  upper  limit  of  the  effusion ;  at  2,  the 
middle  part  of  the  effusion ;  at  3,  its  lower  extremity,  above  the  dorso- 
lumbar  enlargement.  (These  figures  are  taken  from  Ollivier's  work  ;  by 
a  mistake,  the  effusion  is  represented  in  the  left  side  of  the  cord,  instead 
of  the  right.)  (Lecture  VII.,  p.  96.) 

Fig.  21. — Represents  the  decussation  of  the  conductors  for  voluntary  movements 
and  of  those  for  sensations,  a  r,  anterior  roots  continued  by  dotted 
lines  in  the  spinal  cord,  where  they  decussate ;  p  r,  the  posterior  roots 
and  their  decussation ;  g,  the  ganglion ;  m  o,  the  medulla  oblongata ;  r, 
the  right,  and  I,  the  left  side ;  1,  2,  3,  transversal  zones  of  alteration  in 
one  lateral  half  of  the  medulla  oblongata  and  spinal  cord ;  1,  above,  2,  at 
the  level,  and  3,  below  the  decussation  of  the  voluntary  motor  conduc- 
tors. The  arrows  show  the  direction  of  nervous  action  in  the  motor  and 
sensitive  conductors.  (Lecture  VII.,  p.  Ill,  and  Lecture  XII.,  pp.  199 
and  200.) 

Fig.  22. — Represents  the  decussation  of  the  anterior  pyramids. — P,  JD,  decus- 
sation ;  A,  A,  the  right  anterior  column  of  the  spinal  cord  passing  into 
the  right  (the  same)  side  of  the  medulla  oblongata ;  L,  L,  the  right  late- 
ral column  of  the  spinal  cord  forming  the  left  anterior  pyramid  of  the 
medulla  oblongata.  (Lecture  VIIL,  p.  122.) 

Fig.  23. — Represents  the  three  kinds  of  reflex  actions ;  p  r,  posterior  root  of  a 
spinal  nerve  entering  into  the  spinal  cord,  and  connected  by  a  dotted  line 
with  three  nerves ;  one  going  to  a  gland,  gl,  another  to  a  muscle,  m,  and 
the  third  to  a  bloodvessel,  v.  The  arrows  indicate  the  direction  of  nerv- 
ous action,  which,  on  reaching  the  gland,  produces  a  secretion ;  the  mus- 
cle a  contraction,  and  the  bloodvessel  and  surrounding  tissues  a  modi- 
fication of  nutrition.  (Lecture  X.,  p.  152.) 
Fig.  24. — Posterior  surface  of  the  pons  Varolii  and  medulla  oblongata,  partly 
divided  all  along  the  median  line,  to  show  the  decussation  described  by 
Valentin  and  Foville.  C,  G  (instead  of  B,  B,  as  stated  in  the  text,  p. 
198),  the  pretended  decussation  of  the  olivary  columns  in  the  pons  Va- 
rolii, and  between  the  crura  cerebri ;  D,  D  (instead  of  M,  N,  as  in  the 
text,  p.  198),  the  posterior  tubercula  quadrigemina  ;  S,  pineal  gland  ;   T, 


276  EXPLANATION    OF    THE    PLATES. 

optic  tlialami ;  F,  the  nib  of  the  calamus  scriptorius ;  j,  valve  of  Yieus- 
sens  ;  U,  processus  cerebelli  ad  testes ;  U,  processus  cerebelli  ad  medul- 
lam  oblongatam  ;  U",  crus  cerebelli  (processus  cerebelli  ad  pontem)  ;  Y. 
restiform  body;  R,  R,  corpora  geniculata.  (Lecture  XII.,  pp.  198-200.) 

Fig.  25. — A  part  of  the  inferior  surface  of  the  encephalon. —  V,  pons  Varolii: 
/;.  the  part  of  the  anterior  surface  of  the  crus  cerebelli  (processus  cere- 
belli ad  pontem),  which  causes  a  paralysis  on  the  corresponding  side, 
when  irritated  (marked  c,  c,  in  the  text,  p.  201) ;  a,  anterior  pyramid :  o, 
olivary  body ;  p,  a  section  of  the  crus  cerebelli  of  the  left  side ;  c,  cere- 
bellum dissected,  so  as  to  show  the  passage  through  it  of  the  fibres  of 
its  peduncle,  the  crus  cerebelli;  t,  the  trigeminal  nerve;  n,  the  chiasma 
of  the  optic  nerve.  (Lecture  XIL,  pp.  198-201,  and  Appendix,  pp.  263, 
265.) 

Fig.  26. —  V,  the  pons  Varolii;  c,  tlje  cerebellum;  a,  a  tumor  upon  the  crus 
cerebelli :  p-  the  anterior  pyramid  ;  m,  a  transversal  section  of  the  medulla 
oblongata.  (Appendix,  pp.  264-5.) 


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